THE  UNIVERSITY 
OF  ILLINOIS 
LIBRARY 


MOTE  STORAGE 


PRACTICAL  DIETETICS 
WITH  REFERENCE  TO 
DIET  IN  DISEASE  ^ 


PRACTICAL 


DIETETICS 

WITH  REFERENCE  TO 

DIET  IN  DISEASE 

BY 

ALIDA  FRANCES  PATTEE 

Graduate,  Department  of  Household  Arts,^  State  Normal  School, 

Framingham,  Mass. 
Late  Instructor  in  Dietetics,  Bellevue  Training  School  for  Nurses, 

Bellevue  Hospital,  New  York  City. 
Former  Instructor  at  Mount  Sinai,  Hahnemann,  and  the  Flower 
Hospital  Training  Schools  for  Nurses,  New  York  City; 
Lakeside,  St.  Mary's,  Trinity,  and  Wisconsin  Training 
Schools  for  Nurses,  Milwaukee,  Wis.;  St.  Joseph's 
Hospital,  Chicago,  111.;  St.  Vincent  de  Paul 
Hospital,  Brockville,  Ontario,  Canada. 

NINTH  EDITION 
Revised  and  Enlarged 
Price  $1.50 


A.  F.  PATTEE,  Publisher 

Mount  Vernon,  New  York 
1915 


Set  uf),  electrotyped,  printed,  and  copyrighted,  June,  1903 
Reprinted  July,  1904,  February,  1905,  October,  1906,  and  November,  1908 
Revised,  reset,  and  recopyrighted  December,  1910 
Reprinted  August,  1912,  October,  1913 
December,  1914 

Copyright,  1903,  1904,  1905,  1910,  by 
ALIDA  FRANCES  PATTEE 


Entered  at  Stationers'  Hall 
All  rights  reserved 


6  lb.?. 


REMOa 


Zo  tbe  ZTrainct)  iRurec: 
MhOBC  Mil^  life  is  a 
bXeesiriG  to  bumaniti? 


311202 


PEEPACE  TO  THE  SIXTH  EDITION" 


The  very  gratifying  demand  for  this  work  has  necessitated 
the  preparation  of  a  sixth  edition.  Advantage  has  been 
taken  of  this  opportunity  to  revise  the  book  and  incorporate, 
as  far  as  space  allows,  the  latest  results  of  research  in  die- 
tetics. To  meet  the  growing  tendency  of  physicians  to  pre- 
scribe the  exact  fuel  value  of  a  diet,  the  total  energy  value 
of  each  recipe  has  been  calculated  wherever  data  as  to  com- 
position of  materials  used  are  available,  or  the  quantities 
of  materials  used  are  fairly  constant.  A  table  has  also  been 
introduced  in  which  the  food  value  of  the  materials  used  in 
the  recipes  is  given.  This  will  be  useful  in  computing  other 
food  combinations,  and  in  calculating  the  amount  of  protein, 
fat  or  carbohydrates  in  any  dietary,  whenever  required,  with- 
out the  tedious  mathematical  processes  usually  involved  in 
such  operations. 

It  is  hoped  that  a  revised  classification  of  food  principles, 
greater  emphasis  on  the  value  of  mineral  matter  in  the  diet, 
and  fuller  discussion  of  the  fundamental  principles  of  nutri- 
tion, will  add  much  to  the  usefulness  of  the  book. 

In  the  introduction  are  presented  outlines  showing  the  re- 
quirements  in  dietetics  of  the  various  State  Boards  of  Ex* 
aminers  of  Nurses,  and  the  contents  of  the  book  have  been 
rearranged  to  correspond  directly  with  these  requirements. 
This  will  materially  aid  the  dietitian  in  arranging  the  course 
of  study  for  the  nurse  so  as  to  prepare  her  adequately  for  her 
State  Examinations. 

Many  years  of  experience  as  an  instructor  in  dietetics  in 
hospitals  seem  to  the  author  to  demonstrate  that  the  "recipe 
book/^  so-called,  should  not  be  separate  from  the  volume 
on  "theory.'^    Both  theoretical  and  practical  work  should  be 

vii 


viii 


PREFACE 


treated  together,  otherwise^,  while  the  subjects  are  naturally 
closely  allied,  the  young  student  becomes  confused  and  is  not 
apt  to  apply  the  theory  to  the  practice.  In  this  book  she 
cannot  read  a  recipe  without  having  her  attention  called  to 
its  function  in  nutrition.  Furthermore,  for  convenience 
sake,  the  two  should  be  combined  in  one  book  of  moderate 
size.  One  hundred  and  fifty  pages  have  been  added  to  this 
edition  with  but  little  increase  in  bulk. 

I  take  pleasure  in  acknowledging  the  valuable  assistance 
rendered  by  Dr.  Mary  D.  Swartz  Eose,  Assistant  Professor 
of  Household  Arts,  Teachers  College,  Columbia  University, 
New  York,  in  the  preparation  of  this  edition;  also  again  to 
express  my  thanks  for  valuable  material  used  in  the  book  to 
Mrs.  Ellen  H.  Eichards,  Dr.  W.  Oilman  Thompson,  Dr.  Max 
Einhorn,  Dr.  Henry  Koplik,  Dr.  L.  Emmett  Holt,  Dr.  Louis 
Starr,  Dr.  Frederick  C.  Shattuck,  Dr.  Elbridge  G.  Cutler,  Dr. 
Elliott  P.  Joslin,  Dr.  Harry  W.  Goodall  and  Dr,  Maynard 
Ladd. 

Alida  Frances  Pattee. 

New  York,  December,  1910. 

Extract  From  Preface  to  Fifth  Edition 
I  have  been  particularly  pleased  to  see  "Practical  Dietet- 
ics accepted  as  a  text-book  by  so  many  educational  and  other 
authorities.  Thus  it  is  to  be  found  in  all  hospitals  of  the 
United  States  Army;  it  has  been  recommended  for  use  by  all 
the  various  State  Boards  of  Examiners  of  Nurses  that  have 
thus  far  been  appointed;  it  has  been  adopted  by  the  military 
authorities  in  Canada  for  the  Permanent  Schools  of  Instruc- 
tion for  the  Militia,  and  it  has  also  been  added  to  the  Author- 
ized Text  Book  list  of  the  New  York  City  and  Boston  Public 
Schools. 

New  York,  November,  1908. 


PEEFACE  TO  THE  SECOND  EDITION" 


The  very  cordial  reception  of  the  first  edition  of  Practical 
Dietetics  has  encouraged  a  second  presentation. 

In  the  preparation  of  the  second  issue  the  original  matter 
has  been  thoroughly  revised,  and  important  additions  made. 

Por  valuable  material  I  am  indebted  to  the  following 
physicians,  hospitals  and  publishers,  and  gratefully  acknowl- 
edge their  assistance  and  kind  permission  accorded  by  them 
to  quote  their  several  diets. 

Dr.  W.  Oilman  Thompson,  Professor  of  Medicine  in  the 
Cornell  University  Medical  College  in  New  York  City  and 
visiting  physician  to  the  Presbyterian  and  Bellevue  Hos- 
pitals : 

Dr.  Max  Einhorn,  Professor  of  Clinical  Medicine  at  the 
New  York  Post-Graduate  Medical  School  and  Hospital,  vis- 
iting physician  to  the  German  Dispensary: 

Dr.  Henry  Koplik,  attending  physician  Mount  Sinai  Hos- 
pital, ex-president  of  the  American  Paediatric  Society: 

Dr.  L.  Emmett  Holt,  Professor  of  Diseases  of  Children 
in  the  College  of  Physicians  and  Surgeons  (Columbia  Uni- 
versity), attending  physician  at  the  Babies'  Hospital  and 
Foundling  Hospital,  New  York : 

Dr.  Louis  Starr,  Consulting  Paediatrist  to  the  Maternity 
Hospital,  Philadelphia;  late  Clinical  Professor  of  Diseases 
of  Children  in  the  Hospital  of  the  University  of  Pennsyl- 
vania : 

Dr.  Frederick  C.  Shattuck,  Professor  of  Clinical  Medicine 
in  Harvard  University,  visiting  physician  Massachusetts  Gen- 
eral Hospital: 

Dr.  Elbridge  G.  Cutler,  Instructor  in  Theory  and  Prac- 
tice at  Harvard  Medical  School,  visiting  physician  Massa- 
chusetts General  Hospital: 

ix 


X 


PREFACE 


Dr.  N'athan  Smith  Davis^  late  Dean  Northwestern  Uni- 
versity Medical  School,  Chicago: 

Bellevue  Hospital,  Mount  Sinai  Hospital,  the  Presby- 
terian Hospital,  the  Society  of  Lying-in  Hospital  (Xew 
York),  Massachusetts  General  Hospital,  Boston: 

D.  Appleton  &  Co.,  Blakiston  &  Co.,  William  Wood  & 
Co.,  and  the  publisher  of  the  Dietetic  and  Hygienic  Gazette : 

And  sincere  thanks  are  due  Mrs.  Ellen  H.  Eichards  (In- 
structor in  Sanitary  Chemistry,  Massachusetts  Institute  of 
Technology)  for  aid  and  information,  also  for  permission  to 
quote  from  the  Eumford  Kitchen  Leaflets. 

A.  F.  Pattee. 

New  York,  July,  1904. 


PEEFACE  TO  THE  PIEST  EDITION 


As  instructor  of  dietetics  at  various  hospitals  I  have  con- 
stantly felt  the  need  of  a  simple  manual  and  text-book  for 
the  use  of  the  nurse  in  the  classroom. 

Kone  could  be  found  which  fulfilled  the  requirements  as 
to  simplicity,  brevity,  and  exactness,  with  reference  to  dietetic 
treatment  in  disease. 

This  same  need  has  been  expressed  by  mothers  and  nurses 
outside  of  the  hospital. 

In  the  following  pages  I  have  endeavored  to  meet  this 
need  by  giving  the  result  of  knowledge  gained  during  the 
past  eight  years  of  practical  classwork  experience  in  hospitals 
of  different  cities. 

The  preparation  of  food  is  a  science  as  well  as  an  art,  the 
chemistry  of  which  is  as  precise  as  the  chemistry  of  the 
laboratory.  When  we  are  willing  to  be  as  exact  and  care- 
ful in  this  work  as  we  are  in  chemical  experiments,  our  suc- 
cess will  become  a  certainty.  Xo  other  technical  art  can,  with 
so  little  practical  knowledge,  go  as  far  in  simplifying  that 
which  is  otherwise  complicated  and  laborious,  or  do  more 
toward  accomplishing  that  which  is  a  chief  result  of  all 
science —  adding  to  the  comfort  and  happiness  of  the  human 
race. 

A.  P.  Pattee. 

New  York,  July,  1903. 


INTEODUCTION 


In  response  to  the  many  requests  of  Superintendents  of 
Training  Schools  and  Dietitians  for  an  outline  of  the  va- 
rious State  Board  Eequirements  in  Dietetics,  I  herewith 
quote  with  permission  the  following  outlines  of  courses  of 
study  recommended  by  the  American  Hospital  Association, 
New  York,  Minnesota,  Illinois  and  Colorado  State  Boards 
of  Examiners  of  Nurses.  Answers  to  all  questions  are  to 
be  found  in  this  book.  Eequirements  of  other  States  when 
issued  will  be  added  in  each  new  edition  of  "  Practical 
Dietetics.^^ 

These  outlines  will  prove  of  assistance  to  the  Dietitian  in 
arranging  her  course  of  study  for  the  nurse,  and  will  also 
prove  suggestive  to  the  nurse  in  preparing  for  her  State 
Examinations. 

Through  the  kindness  of  the  various  State  Boards  of  Ex- 
aminers of  Nurses  I  am  also  able  to  quote  the  examination 
questions  of  various  States. 

Course  of  Study  in  Dietetics  Arranged  by  the  American 
Hospital  Association 

PRELIMINARY  TERM 
Dietetics:    Classification  of  foods,  care  of  foods,  cooking  of  foods, 
serving  of  foods. 

First  Year 

Tray  setting  and  food  serving;  feeding  the  helpless  and  delirious 
patients;  management  of  liquid  diet. 

Second  and  Third  Year 
Milk  modification  for  infants  according  to  different  formulae;  also 
for  fever  patients  and  invalids.    "  It  is  recommended  that  continued 
and   special  attention  be  given  throughout  the   second  year,  to 
dietetics,  hygiene  and  the  management  of  special  diseases." 

xiii 


xiv  INTRODUCTION 

Second  Year  Theoretical  Work 
Foods  and  food  value;  eight  to  fourteen  hours. 

Third  Year  Practical  Work 

Diet  kitchen  practice,  including  the  modification  of  milk,  one  to 
two  months. 

Course  of  Study  in  Dietetics  Arranged  by  the  Colorado  State 

Board 

Dietetics 

FOOD  —  DEFINITION  —  CLASSIFICATION 

1.  Organic  — 

a.  Proteids. 

b.  Fats. 

c.  Carbohydrates. 

2.  Inorganic  — 

a.  Water. 

b.  Salts. 

3.  Tlie  uses  of  foods  in  disease. 

4.  Practical  work  should  be  given  in  at  least  twelve  (12)  lessons 

and  should  include  plain  and  fancy  cooking  for  in- 
valids. 

5.  Pupils  should  be  familiar  with  the  text  of  either  Pattee,  Farmer 

or  equivalent. 

Course  of  Study  in  Dietetics  Arranged  by  the  Illinois  State 

Board 

PRELIMINAPvY  TERM 
Dietetics 
Second  Four  Weeks 
Simple    nourishments.    Hospital    diet    lists.    Times   of  feeding. 
Methods  of  feeding.    Preparation  of  the  following,  to  be  served  to 
patients : 

Milk,  cold  and  hot.  Malted  milk,  cold  and  hot.  Lemonade.  Beer. 
Gruel.  Egg-nog.  Orangeade.  Root  Beer.  Soda -pop.  Buttermilk. 
Fruit  Juices.  Broth. 

First  Year 

Diet  Cooking:     12  practical  demonstrations,  2  hours  eficlu 


INTRODUCTION 


XV 


Course  of  Study  in  Dietetics  Arranged  by  the  Michigan  State 
Board  of  Examiners  of  Nurses 

LECTUEE  COURSE:  JUNIOR  YEAR 
Dietetics 
FOUR  LECTURES 

1.  Foodstuffs  and  their  classification. 

2.  Principles  of  cooking. 

3.  Beverages:    Milk,  etc. 

4.  Serving  of  food,  combination  of  food  and  12  lessons  in  practical 

demonstration  in  diet  kitchen.  Written  examination  to  be 
held  at  the  end  of  lectures. 

Course  of  Study  in  Dietetics  Arranged  by  the  Minnesota  State 

Board 

SECOND  YEAR 

Dietetics 
Theoretical  Work 
(Anatomy  and  Physiology  of  digestion.    Review  subject  as  al- 
ready given  in  Anatomy,  i.  e. —  mechanical  and  chemical  processes, 
absorption,  assimilation,  metabolism,  elimination.) 

Food  —  definition  of,  source,  function,  composition,  classification 
and  food  adjuncts. 

Water  —  minerals,  fats  and  oils,  carbohydrates  and  proteids,  each 
studied  as  to  their  composition,  food  value,  digestion  and  compara- 
tive values. 

General  principles  to  be  observed  in  cooking  of  starch,  meat,  eggs, 
poultry,  game,  fish,  cereals  and  vegetables. 

Practical  Work 

Dietetics  —  24  two-hour  lessons  —  individual  class  work  under 
dietitian.  (15  minutes  to  theory  and  remainder  of  period  to  prac- 
tical work.) 

Practical  work  to  include  the  proper  methods  of  preparing  and 
serving:  Coffee,  tea,  cocoa,  chocolate,  beef  juice,  beef  broth,  chicken 
broth,  oyster  broth,  egg-nog,  albumin,  milk.  Cream  soups  (tomato, 
corn,  celery,  pea ) .  Toast,  croutons,  pulled  bread.  Bread  —  graham, 
wheat,  whole  wheat,  gluten,  nut.  Light  desserts  —  cornstarch,  gela- 
tin, ices,  ice  cream,  baked  apples.  Eggs  —  soft-boiled,  poached, 
creamed,  custard,  omelet.  Beefsteak,  lamb  chops,  roast  beef,  roast 
lamb,  bacon,  sweetbreads,  scraped  beef.  Chicken  and  game.  Baked 
and  broiled  whitefish,  halibut,  bass,  brook  trout,  oysters.  Rice,  oat- 
meal,   cream    of    wheat,    rolled    oats.    Potatoes  —  baked,  boiled. 


xvi 


INTRODUCTION 


creamed,  escalloped  and  stuffed.  Fruits  —  stewed  and  fresh.  Sal- 
ads —  French  salad  dressing,  cooked  salad  dressing,  mayonnaise^ 
Vegetables. 

Course  of  Study  in  Dietetics  Arranged  by  the  Missouri  State 
Board  of  Examiners  of  Nurses 

Dietetics 
FIRST  YEAR 
Probationary  Course.    Two  to  Four  Months 
Tray  setting  and  food  serving;  feeding  of  helpless  patients;  man- 
agement of  liquid  diet. 

FIRST  YEAR 
Probationary  Course.    Two  to  Four  Months 
Dietetics.     (Theoretical  and  practical  work.)    Pattee's  Practical 
Dietetics.    Part  1. 

SECOND  YEAR 
First  Half.    Intermediate  Term  (4%  months) 
Dietetics.     (Theoretical  and  practical  work.)    Pattee's  Practical 
Dietetics.    Part  2. 

Course  of  Study  in  Dietetics  Arranged  by  the  New  York  State 

Board 

PRELimNARY  TERM 
Dietetics,  14  hours 
Theory 

Water:  source,  function,  varieties  of  drinking  water,  source  of 
disease. 

Beverages:  tea,  coffee,  cocoa,  chocolate;  history  and  growth  of 
plants;  composition,  nutritive  value;  physiological  effects. 

Constituents  of  milk:  care  and  preservation;  bacteria  in  milk;  ef- 
fects of  lieat  on  milk;  adulteration  —  digestibility;  value  of  skimmed 
milk;  whey,  buttermilk,  cheese. 

Infant  feeding;  comparison  of  human  and  cow's  milk;  modifica- 
tion of  milk;  certified  milk;  capacity  of  infant's  stomach;  symp- 
toms considered  in  regulating  the  feeding  of  infants. 

Practical 

Care  of  dining-room,  gas  range,  cooking  utensils,  ice  box  and  con- 
tents. 

Preparation  of  trays;  liow  to  make  them  attractive;  liow  to  serve; 
quantity,  quality  and  temperature  of  food;  how  to  feed  helpless 
patients. 


INTRODUCTION 


xvii 


Beverages:  water,  tea,  coffee,  cocoa,  chocolate,  wines,  fruit  juices, 
malted  milk,  prepared  foods. 

Milk:  pasteurizing,  sterilizing,  modification,  kumyss,  buttermilk 
(artificial)  and  whey. 

Eggs  in  various  forms  as  liquid  diet;  gruels. 

Milk  and  eggs  as  food;  custards;  junket;  white  sauce;  cottage 
cheese. 

INTERMEDIATE  TERM,  FIRST  HALF 
Dietetics,  10  two-hour  lessons  (under  dietitian) 
Theoretical 

Digestion  and  absorption:  review  subject  of  digestion  as  already 
given  in  anatomy,  i.  e.,  mechanical  and  chemical  processes,  absorp- 
tion, assimilation,  metabolism,  elimination  of  waste. 

Food:  source,  function,  food  adjuncts,  definition  of  food,  compo- 
sition, classification. 

Mineral  matter:  source  and  function. 

Carbohydrates:  why  so  called,  source,  function,  nutritive  value. 
General  principle  in  cooking  cereals,  vegetables,  fruits,  nuts  and 
sugars. 

Eggs:  composition;  test  for  freshness;  digestibility;  nutritive  val- 
ues; efl'ect  of  temperature;  advantages  and  disadvantages  in  use. 

Meat:  composition;  nutritive  value;  effect  of  hot  and  cold  water; 
comparative  value  of  tea  and  broth;  raw  compared  with  cooked; 
organs  used  as  food;  gelatin. 

Poultry:  game. 

Fish:  classes;  composition;  signs  of  freshness;  care  of  fish;  nutri- 
tive value;  digestibility. 
Mollusks :  crustaceans. 

Fats  and  oils:  source,  animal  and  vegetable;  function;  digestibil- 
ity; comparative  value  as  fuel  food. 

Practical 

Toast;  cereals;  cornstarch;  macaroni;  rice;  sandwiches. 
Starchy  vegetables,  legumes. 

Green  vegetables,  salads,  dressings  (cream  and  oily) 

Fruit,  fresh  and  cooked;  fruit  puddings. 

Soups,  stock  and  creamy;  broths. 

Broiled  meats,  giving  cuts. 

Chicken  and  game. 

Fish,  shell  and  scaly. 

Frozen  desserts;  sponge  cake;  wafers. 

If  the  pupils  are  not  assigned  to  a  term  of  service  in  the  diet 
kitchen,  practice  in  preparing  and  serving  full  meals  should  be  given 
in  connection  with  this  series  of  lessons. 


xviii 


INTRODUCTION 


SENIOR  TKRM 
Dietetics 
Theory,  at  least  6  hours 

Diet  in  childhood. 
Diet  in  disease. 
Food  values. 

Comparison  of  animal,  vegetable  and  mixed  diets. 
Calculating  dietaries. 
Planning  menus. 

Practical 

During  the  term  the  nurse  in  charge  of  wards  should  make  prac- 
tical application  of  the  theory  of  dietetics  and  study  food  ordered 
for  patients  under  her  care,  in  connection  with  the  cases  for  which 
it  is  ordered. 

Course  of  Study  in  Dietetics  Arranged  by  the  Oregon  State 
Board  of  Examiners  of  Nurses 

PRELIMINARY  TERM 
Dietetics 
Second  Four  Weeks 
Simple    nourishments.    Hospital   diet   lists.    Times   of  feeding. 
Methods  of  feeding.    Preparation  of  the  following,  to  be  served  to 
patients : 

Milk,  cold  and  hot.  Malted  milk,  cold  and  hot.  Lemonade.  Beer. 
Gruel.  Egg-nog.  Orangeade.  Root  Beer.  Soda-pop.  Buttermilk. 
Fruit  Juices.  Broth. 

First  Year 

Diet  Cooking:    12  practical  demonstrations,  2  hours  each. 

Course  of  Study  in  Dietetics  Arranged  by  the  Pennsylvania 
State  Board  of  Examiners  of  Nurses 

Dietetics 
PRELIMINARY  COURSE 
Second  Week 

Serving  of  trays  and  feeding  helpless  patients.    Three  hours  daily. 

TWO  YEARS  COURSE 
First  Year 

Lecture      I.    Foodstuffs  and  their  classification. 
Lecture    II.    Principles  of  cooking. 
Lecture  IT  I.    Beverages,  Milk. 

Lecture  IV.    Serving  of  food.    Combination  of  food. 


INTRODUCTION 


xix 


Lecture     V.    Relation  of  diet  and  nutrition. 
Lessons;  Twelve. 

Practical  demonstration  in  diet  kitchen  on  care  of 
gas  range,  electric  range,  cooidng  utensils  and 
ice  box. 

Preparations  of  trays. 

Feeding  of  helpless  patients. 

Preparation  of  food. 

Second  Year 

Lecture      I.    Carbohydrates;  their  sources,  food  values  and  prepara- 
tion. 

Lecture    II.    Meats;  their  food  values  and  methods  of  preparation. 
Lecture  III.    Eggs;  their  value,  tests  for  freshness,  and  preparation. 
Lecture    IV.    Fish,  clams,  oysters;  their  food  value,  and  prepara- 
tion. 

Lecture     V.    Special  diets  in  different  diseases. 
Lessons ;  Twelve. 

Practical  demonstrations  in  diet  kitchen,  preparing 
and  serving  the  different  varieties  of  food. 

THREE  YEARS  COURSE 
The  same  as  first  and  second  year's  Couri^e  with  the  addition  of 
the  following  matter:  — 

Computing  cost  of  foods. 
Computing  food  values. 

Planning  menus  for  people  in  health  and  disease. 

Feeding  of  children,  sick  and  well. 

Dietary  for  special  diseases. 

Practical  work  in  diet  kitchen  with  instructor. 

Course  of  Study  in  Dietetics  Arranged  by  the  Vermont  State 
Board  of  Examiners  of  Nurses 

Dietetics 

Classification  of  foods,  care  of  foods,  cooking  of  foods,  serving  of 
foods. 

Tray-setting  and  food  serving:  feeding  of  helpless  and  delirious 
patients;  management  of  liquid  diet. 

Course  of  Study  in  Dietetics  Arranged  by  the  Wisconsin  State 
Board  of  Examiners  of  Nurses 

Dietetics 
FIRST  YEAR 
Probationary  Course.    Three  Months. 
Feeding  helpless  patients.    Serving  liquid  diets  under  direction. 
Charting  diets. 


XX 


INTRODUCTION 


SECOND  TEEM  JANUARY  3  TO  MAY  31 
Dietetics. —  T^velve   classes.    Theory,   one-half   hour.  Demonstra- 
tion,  one   and   one-half   hours.    Review   physiology   of  digestion; 
mechanical  and  chemical  processes;   absorption;   assimilation,  and 
elimination. 

Foods. —  Classification,  composition,  and  function. 
Food  values. 

Principles  to  be  observed  in  the  preparation  of  foods. 

Practical  Dietetics. —  Preparation  and  serving  of  the  following : 
Coffee,  tea,  chocolate,  cocoa,  broths,  hot  milk,  oyster  stew,  egg-nog, 
eggs  (poached,  scrambled,  jellied,  baked),  omelets,  custards,  toasts, 
cream  sauce,  light-desserts  (including  ice  cream),  beefsteak,  roasts, 
bacon,  sweet  breads,  fish,  chicken,  breakfast  foods,  vegetables,  fruits, 
and  simple  salads. 

Serving  of  trays. 


state  Examination  Cluestions  in  Dietetics 


COLORADO 
1909 

1.  Mention  one  good  nutritive  enema. 

2.  What  is  included  under  the  head  of  liquid  diet? 

3.  How  do  you  make  albumin  water? 

4.  What  is  the  appearance  of  healthy  beef;  chicken;  fish? 

5.  How  would  you  feed  a  typhoid  patient  the  first  week  he  gets 
solid  food? 

6.  Describe  all  the  correct  methods  you  know  of  preparing  food 
for  the  sick. 

7.  W^hat  is  important  in  cooking  starchy  foods? 

8.  What  foods  contain  the  most  albumin? 

9.  If  you  wish  to  keep  the  juice  in  meat,  how  do  you  cook  it? 
10.  Have  you  had  any  special  training  in  dietetics?    Of  what  did 

it  consist?  Name  one  book  on  dietetics.  Do  you  own  a  book  on 
dietetics  ? 

1911 

1.  (a)  Define  dietetics.  (6)  Wliat  are  nitrogenous  foods  and 
what  is  their  chief  function? 

2.  (a)  What  do  you  understand  by  predigested  foods?  (h)  By 
modified  milk? 

3.  Has  skimmed  milk  any  great  value  as  a  food?    Give  reason. 

4.  (a)  By  what  signs  do  you  know  a  fresh  egg  without  break- 
ing? (6)  Which  are  more  easily  digested,  raw  or  soft-cooked  eggs? 
(c)  Give  a  proper  method  of  preparing  a  soft-boiled  egg. 

5.  (a)  Which  has  the  higher  nutritive  value,  fish  or  meat?  (6) 
Which  is  more  easily  digested? 

6.  {a)  By  what  signs  do  you  know  good  beef?  (&)  By  what 
signs  do  you  know  good  fish? 

7.  Give  a  good  method  of  preparing  beef  juice  and  state  what 
cuts  of  beef  are  best  for  this  purpose? 

8.  (a)  What  is  included  under  the  head  of  light  diet?  (6)  Why 
is  butter  valuable  as  a  food? 

9.  How  do  you  increase  the  digestibility  of  starchy  foods?  Give 
reason. 

10.  {a)  What  instruction  have  you  had  in  dietetics?  (6)  Give 
name  of  one  book  on  dietetics  with  which  you  are  familiar. 

xxi 


xxii 


INTRODUCTION 


1912 

1.  Define  dietetics. 

2.  What  processes  are  necessary  to  make  food  of  use  to  the  body? 

3.  Name  two  vegetables  containing  a  large  proportion  of  carbo- 
hydrates. 

4.  What  food  principles  predominate  in  nuts? 

5.  Why  is  a  salt  free  diet  often  ordered  where  there  is  edema  ? 

6.  How  are  broths  made?  Mention  two  w^ays  of  removing  fats 
from  soups. 

7.  How  sterilize  water?  How  oxygenate  the  same  after  it  is 
sterilized  ? 

8.  What  do  you  understand  by  predigested  food?  By  modified 
milk? 

9.  Give  a  good  method  for  preparing  beef  juice  and  state  what 
cuts  of  beef  are  best  for  this  purpose. 

10.  What  should  be  the  diet  of  a  tubercular  patient  in  the  incipi- 
ent stage? 

1913  — A 

1.  How  much  practical  work  have  you  had  in  dietetics?  Name 
text  book  used. 

2.  What  diseases  may  result  from  the  following:  improperly  bal- 
anced diet,  insufficient  food,  over  feeding,  and  lack  of  fresh  food? 

3.  By  what  signs  do  you  know  a  fresh  egg  without  breaking? 
Which  are  more  easily  digested,  raw  or  soft  cooked  eggs  ?  Give  a 
good  method  of  preparing  a  soft  boiled  egg. 

4.  What  is  included  under  the  head  of  light  diet?  Why  is  but- 
ter valuable  as  a  food? 

5.  Has  skimmed  milk  any  great  value  as  a  food?  Give  reason. 
What  do  you  understand  by  predigested  foods? 

6.  What  is  meant  by :  "  certified  milk,"  "  pasteurized,"  "  modified 
milk"?    Outline  one  day's  diet  for  a  child  three  years  of  age. 

7.  What  should  be  the  diet  of  a  tuberculosis  patient  in  the  in- 
cipient stage? 

8.  What  is  the  most  wholesome  way  of  cooking  meat  for  invalids? 
Name  tlie  kind  of  meats  they  should  have. 

9.  How  much  fluid  should  be^  drunk  daily  under  ordinary  cir- 
cumstances? What  time  of  day  is  the  drinking  of  water  especially 
beneficial,  and  how?    How  make  albumin  water? 

10.  Classify  food  under:  source,  chemical  composition  and  func- 
tion.   Give  a  formula  for  a  good  nutritive  enema. 

1913  — B 

1.  Define  dietetics. 

2.  Wliat  processes  are  necessary  to  make  food  of  use  to  the  body? 


INTRODUCTION 


xxiii 


3.  Name  two  vegetables  containing  a  large  proportion  of  carbo- 
hydrates. 

4.  What  food  principles  predominate  in  nuts? 

5.  Why  is  a  salt  free  diet  often  ordered  where  there  is  edema? 

6.  How  are  broths  made?  Mention  two  ways  of  removing  fats 
from  soups. 

7.  How  sterilize  water?  How  oxygenate  the  same  after  it  is 
sterilized? 

8.  What  do  you  tinderstand  by  predigested  food  ?  By  modified 
milk? 

9.  Give  a  good  method  for  preparing  beef  juice  and  state  what 
cuts  of  beef  are  best  for  this  purpose. 

10.  What  should  be  the  diet  of  a  tubercular  patient  in  the  incipient 
stage  ? 

1914  — A 

1.  Name  five  diseases  where  special  diet  is  necessary  in  overcom- 
ing the  disease. 

2.  What  is  included  under  the  head  of  light  diet?  What  are 
predigested  foods? 

3.  How  do  you  increase  the  digestibility  of  starchy  foods?  Give 
reason. 

4.  What  foods  should  be  avoided  if  there  is  a  tendency  to  flatu- 
lency ? 

5.  Describe  the  process  of  making  tea,  giving  the  reason  for  this 
process. 

6.  What  is  lactose  and  where  found?  Name  the  substitute  for 
sugar^. 

7.  What  is  ''top  milk"?    How  sterilize  milk? 

8.  Describe  the  best  method  of  cooking  steak.  How  do  you  make 
beef  juice? 

9.  Name  the  principal  elements  contained  in  foods. 

10.  What  is  the  general  opinion  of  the  effect  of  alcohol  on  tuber- 
culous patients  ?  Name  the  beverages  that  are  of  great  benefit  in  this 
disease. 

1914  — B 

1.  Why  are  green  vegetables  and  fruits  a  valuable  addition  to  a 
general  diet? 

2.  Describe  the  gradual  effect  of  increased  heat  on  the  white  of 
an  egg. 

3.  Why  are  meats  restricted  or  forbidden  in  cases  of  nephritis? 

4.  How  do  you  make  beef  tea  and  broths? 

5.  Mention  two  ways  of  removing  fat  from  soups. 


xxiv 


INTRODUCTION 


6.  Has  skimmed  milk  any  great  food  value?  Why? 

7.  By  what  signs  do  you  know  a  fresh  egg,  good  beef,  and  fresh 
fish? 

8.  What  is  fermentation?    Name  three  kinds. 

9.  What  are  nitrogenous  foods  and  what  is  their  chief  function? 
10.  Give  a  formula  for  modified  milk  to  be  given  an  infant. 

CONNECTICUT 
Dietetics  and  Hygiene 
June,  1909 

1.  Name  the  different  classes  into  which  food  may  be  divided. 

2.  Name  two  animal  and  two  vegetable  foods  which  contain  fat. 

3.  Prepare  a  day's  menu  for  a  patient,  excluding  starchy  foods 
as  far  as  possible,  while  giving  a  variety. 

4.  What  useful  function  may  be  performed  by  the  indigestible 
parts  of  vegetables? 

5.  Show  why  a  mixed  diet  is  advisable. 

6.  Give  one  method  of  predigesting  milk. 

7.  Prepare  a  day's  menu  of  at  least  six  meals  for  a  patient  with 
mild  fever,  excluding  milk,  but  giving  as  much  variety  as  permissi- 
ble in  a  fluid  diet. 

8.  What  are  sweetbreads,  and  how  would  you  prepare  and  serve 
them? 

9.  Why  is  a  thorough  cooking  especially  important  in  cereal 
foods  and  not  in  flesh  foods? 

10.  Write  the  rules  for  preparing  three  desserts  you  would  use 
in  feeding  a  typhoid  fever  patient  during  convalescence. 

11.  Give  a  list  of  fruits  you  would  recommend  for  their  laxative 
effect. 

January,  1910 

1.  Give  a  brief  description  of  the  care  of  glass  drinking  tubes 
used  by  typhoid  patients. 

2.  Give  recipe  for  (1)  partial  peptonisation  of  milk:  (2)  junket. 

3.  Mention  the  foods  allowed  according  to  the  following  classifi- 
cation: (1)  Liquid;  (2)  Soft;  (3)  Light. 

4.  How  would  you  render  the  following  sterile:  (1)  Woolen 
blankets;  (2)  Cotton  sheets;  (3)  Rubber  catheters ;  (4)  Your  hands? 

5.  In  making  up  modification  of  milk  give  in  detail  from  the 
time  you  receive  tlie  milk  until  you  give  it  to  the  infant  the  pre- 
cautions you  would  take  to  keep  certified  milk  pure. 

0.  Tell  what  you  know  of  either  tea  or  coffee,  its  production, 
preparation,  use  and  abuse. 


INTRODUCTION 


XXV 


7.  What  cuts  of  beef  would  you  select  for  the  following  purposes: 
(1)  Beef  juice;  (2)  Roast  beef;  (3)  A  tender  steak? 

8.  What  action  has  prolonged  cooking  on  (1)  starch  grains;  (2) 
albumin  ? 

9.  What  different  methods  would  you  employ  in  cooking  chicken 
for  (1)  broths;   (2)  fricassee?  Why? 

10.  Give  minute  details  of  your  care  of  the  linen  used  on  the  bed 
of  a  scarlet  fever  patient. 

January,  1911 

1.  Describe  the  diet  to  be  given  to  a  patient  after  an  operation 
on  (a)  the  liver,  (b)  the  stomach. 

2.  What  diet  would  you  give  to  a  patient  with  scarlet  fever? 
Give  your  reasons. 

3.  What  is  the  effect  in  cooking  (a)  meat,  (b)  vegetables? 

4.  State  why  green  vegetables  are  valuable  in  diets. 

5.  Give  the  preparation  of  (a)  koumiss,  (b)  whey. 

6.  Give  a  list  of  six  fluid  foods. 

7.  What  are  the  best  natural  disinfectants? 

8.  What  precautions  would  you  take  in  the  use  of  water  where 
the  supply  is  impure? 

9.  What  are  some  of  the  diseases  attributed  to  an  impure  water 
supply? 

10.  Describe  fully  one  method  of  ventilation  for  a  sick  room. 

January,  1912 

1.  Of  what  use  is  gelatin  as  food? 

2.  What  points  must  be  observed  in  the  cooking  and  serving  of 
cereals  ? 

3.  Name  the  five  most  important  food  compounds. 

4.  Name  some  of  the  points  to  be  considered  in  the  amount  of 
food  needed  by  an  individual? 

5.  What  action  do  the  gastric  fluids  have  on  milk?  How  would 
you  prepare  milk  to  make  it  more  digestible? 

6.  What  is  the  effect  of  toasting  bread? 

7.  State  your  reasons  for  adding  salads  to  a  diet? 

8.  What  points  should  be  considered  in  selecting  a  disinfectant? 

9.  In  what  ways  is  scarlet  fever  communicated? 

10.  What  precautions  would  you  take  for  both  your  patient  and 
yourself  before  leaving  quarantine  for  scarlet  fever? 

January,  1913 

1.  State  why  food  should  be  thoroughly  masticated  if  good  di- 
gestion is  to  result. 


xxvi 


INTRODUCTION 


2.  What  are  the  uses  of  fruit  in  a  diet? 

3.  Define  the  terms  (a)  Hygiene,  (6)  Dietetics. 

4.  State  how  you  would  prepare  (a)  barley  water,  (&)  oatmeal 
gruel,  (c)  albumin  water. 

5.  Describe  fully  how  to  prepare  (a)  beef  broth,  (&)  mutton 
broth,  (c)  beef  juice. 

6.  What  are  predigested  foods? 

7.  Why  is  the  study  of  dietetics  a  valuable  asset  in  the  training 
of  a  nurse? 

8.  State  what  you  know  of  the  reason  for  the  present  movement, 
against  nurses  wearing  their  uniforms  on  the  street. 

9.  What  are  comm.unicable  diseases?    Give  a  list  of  them. 

10.  State  fully  how  you  would  disinfect  a  room  in  a  private  house 
after  a  case  of  typhoid  fever. 

June,  1913 

1.  How  would  you  prepare  and  serve  [a)  soft  boiled  egg,  (&) 
poached  egg? 

2.  What  is  a  salt  free  diet,  and  in  what  diseases  is  it  often 
ordered  ? 

3.  Describe  fully  the  diet  for  a  rheumatic  patient. 

4.  Describe  the  following  diets  and  tell  what  can  be  given  under 
the  different  headings,     (a)  Liquid,  (6)  Soft,  (c)  Light. 

5.  Give  the  preparations  of  a  nutritive  enema. 

6.  How  is  lime  water  prepared?    Why  is  it  added  to  milk? 

7.  Give  some  of  the  essential  points  for  a  nurse  to  observe  in 
serving  meals  to  (a)  a  weak  convalescent,  (h)  a  helpless  patient, 
(c)  an  unconscious  one. 

8.  What  are  the  uses  of  condiments?    Give  a  list  of  them. 

9.  Has  a  nurse  any  duties  in  a  home  other  than  the  care  of  lier 
patient? 

10.  Define  the  terms  («)  contagion,  (&)  incubation,  (c)  crisis, 
{d)  quarantine,  (r)  immunity. 

(Tabulate  answers  where  possible.) 

January,  1914 
Dietetics  and  Home  Sanitation 

1.  Why  is  a  mixed  diet  necessary  to  good  health? 

2.  Give  some  ways  in  which  infectious  diseases  may  be  com- 
municated. 

3.  What  processes  are  necessary  to  make  food  of  use  to  the 
body? 

4.  Give  your  methods  of  preparing  (o)  Chicken  broth,  {h)  Clam 
broth,  (c)  Milk  toast,  {d)  Oyster  Stew? 


INTRODUCTION 


xxvii 


5.  Give  the  classifications  of  food,  give  an  example  of  each, 
stating  which  are  tissue  forming  and  which  are  heat  producing. 

6.  What  are  the  points  to  be  observed  in  cooking  (a)  Broths, 
(5)  Meat,  (c)  Cereals. 

7.  Give  all  the  important  duties  to  be  carried  out  in  the  care 
of  infectious  cases  in  a  private  house. 

8.  Give  some  of  the  points  to  be  observed  in  the  modification  of 
milk. 

9.  State  fully  your  advice  to  a  mother  as  to  diet,  etc.,  for  a 
child  6  to  8  years  old  suffering  with  defective  nutrition. 

10.  Give  some  of  the  diseases  communicated  by  the  public  drinking 
cup. 

June,  1914 

1.  N"ame  the  principal  nitrogenous  food  substances  and  tell 
where  each  is  obtained. 

2.  What  causes  milk  to  become  sour? 

3.  What  effect  does  toasting  have  on  the  digestibility  of  bread? 

4.  Why  are  green  vegetables  which  contain  very  little  nourish- 
ment essential  to  health? 

5.  Give  three  menus  for  a  dinner  for  a  patient  allowed  solid 
food,  but  no  meat. 

6.  Describe  the  diet  of  a  patient  with  scarlet  fever,  what  food 
product  is  omitted  at  what  stages,  and  why? 

7.  How  would  you  care  for  the  discharges,  clothing,  dishes  of 
a  typhoid  fever  patient  in  a  private  house? 

8.  W^hat  precautions  would  you  take  in  nursing  a  case  of  typhoid 
fever  for  personal  protection,  what  advice  would  you  give  the  family? 

9.  Give  a  rule  for  making  tea,  coffee,  what  is  the  injurious 
elements  in  each  one? 

10.  Give  some  reasons  why  a  fluid  diet  should  be  given  in  fibrile 
diseases. 

DISTRICT  OF  COLUMBIA 
1908 

1.  Name  three  foodstuffs  rich  in  albumin  in  the  order  of  their 
importance. 

2.  Describe  process  of  digestion  and  absorption  of  albuminoids. 

3.  What  is  the  object  of  cooking  vegetables  and  of  cooking  meats? 

4.  Give  frequency  of  feeding  patient  on  liquid  diet  and  on  plain 
diet;  why  the  difference? 

5.  Name  any  two  diseased  conditions  which  may  be  brought 
about  by  dietetic  error;  state  how? 


xxviii 


INTRODUCTION 


1909 

1.  N'ame  the  different  classes  of  foodstuffs  and  give  an  example 
of  each. 

2.  What  are  the  chief  ingredients  in  fruits? 

3.  Describe  the  action  of  the  gastric  juice  on  food. 

4.  State  the  length  of  time  required  to  cook  properly  the  follow- 
ing cereals:  rolled  oats,  rice,  and  cornmeal  mush. 

5.  Give  the  two  complete  food  products  furnished  by  the  animal 
kingdom. 

ILLINOIS 
January,  1911 

1.  Define  food  and  name  the  five  principles. 

2.  What  are  some  of  the  uses  of  water  in  the  body? 

3.  What  physical  and  mental  conditions  decrease  the  secretion 
of  the  digestive  juices? 

4.  Discuss  the  value  of  (a)  Milk,  (b)  Beef  Tea,  (c)  Beef  Juice. 

5.  Name  some  diseases  that  may  be  caused  by  the  following 
errors  in  diet:  (a)  Insufficient  food,  (b)  Lack  of  fresh  food,  (c) 
Overeating,  (d)  Improperly  balanced  diet. 

July,  1911 

1.  Discuss  feeding  the  sick,  under  the  following  headings:  Gen- 
eral rules,  appetite,  the  tray. 

2.  Define  food.  Name  the  different  classes  of  foodstuffs,  ac- 
cording to  their  chemical  composition,  and  give  the  special  function 
of  each. 

3.  What  is  meant  by  "  certified  milk,"  "  pasteurized  milk,"  "  modi- 
fied milk"? 

4.  Outline  one  day's  diet  for  a  normal  child  three  years  of  age. 

5.  What  diseases  may  result  from:  improperly  balanced  diet,  in- 
sufficient food,  over-feeding,  lack  of  fresh  food. 

January,  1912 

1.  Classify  food  under  (a)  source,  (6)  chemical  composition,  (c) 
function. 

2.  Describe  the  gradual  effect  of  increased  heat  on  white  of  an 
egg  (albumin). 

3.  What  is  lactose  and  where  found? 

4.  (a)  Of  what  use  is  sugar  in  practical  dietetics?  (&)  Wliat 
is  the  sul)stitution  for  sugar,  and  where  found? 

5.  Wliat  are  the  chief  sources  of  fat  in  a  general  diet? 


INTRODUCTION 


xxix 


6.  (a)  What  are  the  food  uses  of  water?  (&)  What  is  distilled 
water  and  why  not  used  as  a  beverage? 

7.  Discuss  diet  in  tuberculosis. 

July,  1912 

1.  (a)  Give  the  theory  of  cooking  starch. 

(b)  What  secretions  assist  in  the  digestion  of  starch? 

2.  (a)  What  are  the  characteristics  of  an  ideal  piece  of  toast? 
(b)  How  is  toast  to  be  served? 

3.  (a)  Why  does  milk  become  sour? 

(b)  Is  sour  milk  harmful? 

(c)  What  preventive  measures  can  be  used  in  summer  to  keep 
milk  from  becoming  sour? 

4.  (a)  Define  foodstuffs. 

(b)  What  are  the  uses  of  foods? 

5.  (a)  What  is  meant  by  a  Calorie? 

(b)  How  many  Calories  are  needed  by  the  average  adult  in 
health? 

G.  Describe  five  ways  of  preparing  milk  and  eggs,  either  separately 
or  together,  with  which  to  vary  a  liquid  diet. 

7.  Name  four  points  which  should  be  considered  in  the  feeding 
of  patients. 

8.  What  changes  take  place  in  the  making  of  wheat  flour  into 
bread  ? 

November,  1913 

1.  (a)  What  reaction  has  Saliva? 

(b)  Name  digestive  process  which  commences  in  the  mouth. 

2.  What  is  food  ? 

3.  What  is  the  essential  point  in  the  nursing  care  of  Diabetic 
patient  ? 

4.  Give  a  menu  for  a  patient  on  "  soft  diet." 

5.  (a)  How  is  milk  Peptonized? 
(b)  How  is  milk  Pasteurized? 

6.  What  is  meant  by  "modification  of  milk"? 

7.  How  would  you  prepare  Barley  Water? 

December,  1913 

1.  What  is  a  Calorie? 

2.  (a)  How  do  you  make  Albumin  Water? 
(b)  How  do  you  make  Junket? 

3.  What  is  a  great  danger  in  frequent  handling  of  milk,  such 
as  transferring  from  one  vessel  to  another? 

4.  What  is  the  principal  composition  of  eggs? 


XXX 


INTRODUCTION 


5.  Where  is  water  chiefly  absorbed? 

6.  Name  two  w^ell  known  food  products  containing  starch. 

7.  How  would  you  make  an  egg  omelet? 

March,  1914 

1.  What  reaction  has  mother's  milk? 

2.  W^hat  and  where  are  Villii  ? 

3.  (a)  What  is  Metabolism? 
(b)  Describe  two  phases. 

4.  (a)  Wliat  is  the  technique  for  giving  rectal  feeding? 
(b)  Describe  preliminary  preparation. 

5.  What  are  active  principles  of  tea  and  coffee? 

6.  Why  is  toasted  bread  more  digestible  than  fresh  bread? 

7.  Why  do  some  cereals  require  long  cooking?    Mention  three. 

July  1-2,  1914 

1.  When  and  why  is  a  salt  free  diet  frequently  ordered? 

2.  WTiat  is  the  advantage  of  sufficient  mastication  of  food? 

3.  Why  are  fats  easily  assimilated? 

4.  (a)  Prepare  beef  juice. 

(b)  Prepare  beef  broth. 

(c)  Describe  nutritive  value  of  each. 

5.  Why  is  the  continued  use  of  predigested  foods  not  advisable? 

6.  In  what  disease  is  low  protein  diet  ordered? 

July  14-15,  1914 

1.  Give  uses  of  food. 

2.  What  are  the  differences  between  cow's  and  human  milk? 

3.  (a)  What  do  you  understand  by  modified  milk? 
(b)  By  certified  milk? 

4.  Why  is  it  necessary  to  restrict  starches  as  well  as  sugar  in 
the  treatment  of  diabetes  ? 

5.  Mention  some  reasons  why  solid  food  is  withheld  or  re- 
stricted when  there  is  a  high  temperature. 

6.  Mention  two  foods  often  given  infants  when  they  are  unable 
to  digest  milk. 

7.  Mention  some  points  to  be  remembered  when  serving  food  to  a 
patient. 

LOUISIANA 
1914 

1.  How  and  what  should  be  the  feeding  of  a  new-born  child  and 
until  what  age  should  same  be  continued? 

2.  When  a  child  begins  taking  solid  food,  state  character  of  food 
and  fiequency  of  feeding. 


INTRODUCTION 


xxxi 


3.  State  the  average  weight  of  child  from  birth  to  one  year. 

4.  What  is  the  relative  food  value  of  starches,  proteids  and  fats? 

5.  Where  does  the  digestion  of  the  above  occur? 

6.  Describe  the  usual  diet  in  typhoid  treatment. 

7.  What  do  you  understand  as  the  caloric  unit? 

8.  Give  approximately  the  food  value  of  cow's  milk. 

9.  What  do  you  understand  by  the  term  Pasteurized  milk? 
10.  Give  post-  and  pre-operative  dieting  of  patients. 

MARYLAND 
October,  1914 

1.  Name  the  five  fundamental  food  principles. 

2.  (a)  Which  of  these  principles  does  milk  contain? 

(b)  Which  of  these  principles  do  eggs  contain? 

(c)  Which  of  these  principles  do  cereals  contain?  (State 
approximate  proportions.) 

3.  What  are  the  essential  points  in  cooking  starchy  foods? 

4.  How  should  meat  be  cooked  in  order  to  retain  its  juices? 
When  is  this  desired? 

5.  How  is  meat  cooked  if  it  is  desired  to  extract  the  juices? 

6.  What  change  is  produced  in  bread  by  toasting? 

7.  Name  several  articles  of  food  that  have  laxative  value. 

8.  What  vegetables  supply  about  the  same  elements  for  the  sys- 
tem as  meat? 

9.  What  are  the  fundamental  characteristics  of  the  diet  in  dia- 
betes? In  acute  nephritis?  In  dysentery?  In  pulmonary  tuber- 
culosis?   In  obesity? 

10.  (a)  Give  receipt  for  making  barley  water, 
(b)  Give  receipt  for  baked  custard. 

MINNESOTA 
October,  1911 

1.  What  do  you  understand  by  "food  value"? 

2.  Give  briefly  the  food  value  of  the  following  articles  of  food: 
Meat,  Spinach,  Dried  Peas,  Milk,  Sugar. 

3.  Define  Casein,  Dextrose,  Caffein,  Legumes,  Kumyss. 

4.  What  value  has  soup  as  a  first  course  for  a  dinner?  What 
value  has  water  in  the  diet? 

5.  Mention  some  foods  you  would  not  give  in  the  following  dis- 
eased conditions,  and  why:  Diarrhoea,  Biliousness,  Obesity,  Dia- 
betes, Gout,  Gastritis. 

6.  Name  the  five  food  classes  and  give  four  articles  of  food 
representing  each. 


xxxii 


INTRODUCTION 


7.  Give  definitely  your  method  of  preparing  and  cooking  the 
following:  Soft  Boiled  Egg,  Rice  Custard,  Beef  Broth,  Cream  of 
Pea  Soup,  Toast,  Cocoa. 

8.  Draw  diagram  of  a  tray  as  you  would  set  it  for  a  bed  patient. 
Mention  some  points  you  would  observe. 

9.  What  is  the  first  process  in  milk  digestion?  What  instruc- 
tions would  you  give  a  patient  on  a  milk  diet  as  to  method  of  taking 
same?    W^hat  is  the  dift'erence  between  mothers'  milk  and  cows'  milk? 

10.  Give  the  process  of  digestion. 

October,  1912 

1.  What  is  the  food  value  of  carbohydrates?  What  are  the 
simplest  forms  of  same? 

2.  Why  does  a  liquid  diet  for  a  person  in  relatively  good  health 
not  prove  equal  to  his  sustenance  despite  its  theoretical  food  value? 

3.  What  is  yeast?  What  makes  bread  rise?  Name  two  other 
leavening  agents? 

4.  What  would  you  consider  the  essential  points  to  be  observed 
in  the  diet  for  the  following  conditions,  and  why? 

(a)   Acute  fevers,     (b)    Constipation,     (c)    Dysentery,  (d) 
A  child  two  years  old.     (e)  Diabetes. 

5.  What  is  the  injurious  principle  in  tea?  In  coffee?  What  the 
stimulating  principle? 

6.  Define:  cellulose,  dextrine,  lactose,  casein,  saccharin. 

7.  Why  is  thorough  cooking  especially  important  in  cereals  and 
not  in  flesh  foods?    What  is  cooking  temperature  of  albumin? 

8.  State  food  values  of  green  vegetables.  What  foods  would  you 
give  a  two  year  old  child  suffering  from  rickets,  and  why? 

9.  Outline  fully  the  process  of  starch  digestion. 

10.  What  are  the  principal  points  to  be  observed  in  the  prepara- 
tion of  the  following  foods,  .and  why?  How  would  you  prepare 
same?  Cup  custard;  Soft  boiled  egg;  Oatmeal;  Beef  juice;  White 
sauce. 

April,  1913 

1.  What  conditions  should  influence  you  in  the  selection  of 
food  in  health? 

2.  Why  is  thorough  cooking  especially  important  in  cereals  and 
not  in  most  flesh  foods? 

3.  How  does  Cocoa  compare  in  nutritive  value  with  Tea  and 
Coffee?    How  would  you  prepare  Cocoa? 

4.  What  are  the  principal  points  to  be  considered  in  the  diet 
in  acute  fevers  and  why? 

5.  What  constitutes  a  perfect  food?    Name  two. 

6.  What  is  cellulose?    What  is  its  use  in  the  body?  Mention 


INTRODUCTION 


xxxiii 


two  foods  which  contain  it.  In  what  condition  should  it  not  be 
given  ? 

7.  How  would  you  peptonize  milk  and  why? 

8.  What  is  the  food  value  of  fats?  Wherein  do  they  differ  from 
carbohydrates  ? 

Why  does  the  cooking  of  starch  in  fat  render  it  less  digestible? 

9.  Outline  carefully  the  digestion  of  starch. 

10.  What  food  classes  do  each  of  the  following  foods  represent? 
What  are  their  uses  in  the  body  and  how  would  you  prepare  them? 
(1)  Cup  Custard,  (2)  Soft  Boiled  Eggs,  (3)  Lettuce  Salad,  (4) 
Cream  of  Pea  Soup,  (5)  Baked  Potato. 

11.  Where  is  protein  principally  digested?  What  is  the  compara- 
tive value  of  animal  and  vegetable  protein? 

12.  WHiy  should  milk  not  be  taken  as  a  beverage  with  meals? 
What  instructions  would  you  give  a  patient  on  a  milk  diet? 

October,  1913 

1.  Name  three  laxative  foods;  three  fattening  foods;  three  con- 
stipating foods. 

2.  Mention  three  diseases  in  which  diet  is  a  most  important  part 
in  the  treatment,  giving  principal  points  in  the  dietetic  treatment  of 
each. 

3.  What  do  you  understand  by  "  light  diet,"  when  no  special  or- 
ders are  given? 

4.  Into  how  many  classes  are  foods  divided?  State  their  use  in 
body,  and  give  two  examples  of  each. 

5.  What  symptoms  would  you  expect  following  too  much  fat  in 
the  diet?    Why  are  starches  cooked  in  fat  indigestible? 

6.  What  do  you  understand  by  the  "  food  value  "  of  any  article 
of  food?  Name  two  articles  of  food  having  great  food  value,  and 
two  that  have  little  food  value. 

7.  What  is  the  cooking  temperature  of  albumin?  At  what  tem- 
perature does  water  boil?  Freeze? 

8.  How  would  you  prepare,  and  what  points  observe,  in  prepara- 
tion of  the  following:  (1)  Soft  boiled  egg;  (2)  Sweetbreads;  (3) 
Oatmeal;  (4)  Coffee;  (5)  Beefsteak;  (6)  Beef  broth;  (7)  Cream 
of  tomato  soup;  (8)  White  sauce. 

9.  Why  is  thorough  mastication  of  food  necessary?  Name  four 
foods  in  the  digestion  of  which  it  is  especially  important. 

10.  Outline  fully  the  process  of  digestion. 

April,  1914 

1.  What  are  the  chief  sources  of  the  carbohydrates?  Outline 
their  digestion. 

2.  Define  sterilization,  pasteurization,  cellulose,  rennin,  gluten. 


xxxiv 


INTRODUCTION 


3.  What  do  you  understand  by  "  food  value  "  ? 

4.  What  is  yeast?    What  makes  bread  rise?    Name  two  other 
leavening  agents. 

5.  W^hy  do  we  toast  bread?    Give  proper  method. 

6.  What  effect  does  cooking  have  on  meat?    What  is  the  cooking 
temperature  of  albumin? 

7.  Give  essential  points  to  be  observed  in  diet  for  the  following 
conditions:  (a)  Constipation,  (b)  Diabetes,  (c)  Dysentery,  (d) 
Tuberculosis,     (e)  Acute  Fevers. 

8.  Name  the  five  food  classes,  giving  briefly  chemical  composition, 
use  in  body  and  examples  of  each. 

9.  What  foods  would  you  give  a  child  who  needed  more  mineral 
matter  ? 

10.  Where  is  protein  principally  digested?    Where  is  starch  prin- 
cipally digested? 

11.  How  would  you  prepare:      (a)    Baked  Custard,    (b)  Soft 
Boiled  Egg.     (c)  Cocoa,     (d)  Beef  Broth,     (e)  Omelet. 

12.  Name  two  diseased  conditions  which  may  be  caused  by  error 
in  diet.    State  how. 

October,  1914 

1.  What  functions  do  nitrogenous  foods  perform  in  the  body? 
Where  are  they  principally  digested?    Name  three. 

2.  In  what  diseased  condition  are  carbohydrates  contra-indicated? 
What  substitutions  could  you  make? 

3.  Outline  proper  arrangement  of  an  invalid's  tray.    What  points 
require  especial  attention? 

4.  What  do  you  consider  the  necessary  requirements  in  diet  of  a 
fever  patient? 

5.  What  is  physical  change?    Chemical  change?    Give  examples 
of  each.  » 

6.  How  would  you  make  coffee?    What  is  the  injurious  principle 
in  coffee? 

7.  What  is  the  cooking  temperature  of  albumin?  Name  four  ar- 
ticles of  food  in  the  cooking  of  which  this  point  should  be  remem- 
bered, and  w^hy? 

8.  What  would  you  consider  improper  cooking  of  starch?  What 
ill  effects  might  result  from  eating  improperly  cooked  starch? 

9.  Name  the  five  food  principles.  Outline  each,  giving  briefly ' 
their  chemical  composition,  uses  in  body  and  examples  of  each. 

10.  What  is  the  food  value  of,  and  how  would  you  prepare  ( 1 ) 
Cup  Custard.  (2)  Baked  Potato.  (3)  Cocoa.  (4)  Soft  Boiled 
Eggs.    (5)  Oyster  Broth. 


INTRODUCTION 


xxxy 


MISSOURI 
June,  1913 

1.  Name  different  classes  of  foodstuffs,  and  give  an  example  of 
each. 

2.  Give  theory  of  cooking  starches,  and  tell  where  and  by  what 
digested. 

3.  (a)  What  is  Predigested  milk?  (b)  Modified  milk?  (c) 
Certified  milk? 

4.  (a)  What  is  the  composition  of  Avater?  (b)  Boiling  point, 
freezing  point?  (c)  How  would  you  render  boiled  water  palatable? 
(d)  How  would  you  boil  water  for  Tea?  (e)  Should  Tea  be  an  In- 
fusion or  a  Decoction? 

5.  Describe  the  process  of  making  (a)  Beef  Tea,  (b)  Beef  Juice. 

6.  (a)  What  should  be  eliminated  from  the  diet  of  a  Dropsical 
patient  ? 

(b)  Why  is  the  diet  of  such  importance  in  Tuberculosis? 

7.  What  is  the  value  of  (a)  Sugar  in  food?  (b)  Mineral  mat- 
ters in  food?     (c)  Condiments? 

8.  How  should  an  egg  be  cooked  for  an  invalid,  and  how  served? 

9.  What  class  of  foods  are  restricted  in  Diabetes?  Give  one 
reason. 

10.  When  is  a  healthy  child  considered  able  to  digest  starchy 
foods?    Give  reason. 

11.  State  some  of  the  advantages  and  disadvantages  of  milk  in  a 
case  of  Typhoid  Fever. 

12.  What  class  of  Vegetables  are  rich  in  Protein? 

13.  Give  two  formulas  for  Rectal  feeding. 

September,  1913 

1.  Name  different  classes  of  foodstuffs,  and  give  an  example  of 
each. 

2.  Give  theory  of  cooking  starches,  and  tell  where  and  by  what 
digested. 

3.  (a)  What  is  Predigested  milk?  (b)  Modified  milk?  (c) 
Certified  milk? 

4.  (a)  What  is  the  composition  of  water?  (b)  Boiling  point, 
freezing  point?  (c)  How  would  you  render  boiled  water  palatable? 
(d)  How  would  you  boil  water  for  Tea?  (e)  Should  Tea  be  an 
Infusion  or  a  Decoction? 

5.  Describe  the  process  of  making  (a)  Beef  Tea,  (b)  Beef  Juice.^ 
0.  (a)  What  should  be  eliminated  from  the  diet  of  a  Dropsical 

patient? 

(b)  Why  is  the  diet  of  such  importance  in  Tuberculosis? 


xxxvi 


INTRODUCTION 


7.  What  is  the  value  of  (a)  Sugar  in  food?  (b)  Mineral  mat- 
ters in  food?     (c)  Condiments? 

8.  How  should  an  egg  be  cooked  for  an  invalid,  and  how  served? 

9.  What  class  of  foods  are  restricted  in  Nephritis?  Give  one 
reason. 

10.  When  is  a  healthy  child  considered  able  to  digest  starchy- 
foods?    Give  reason. 

11.  State  some  of  the  advantages  and  disadvantages  of  milk  in  a 
case  of  Typhoid  Fever. 

12.  What  class  of  Vegetables  are  rich  in  Protein? 

June,  1914 

1.  (a)  Name  the  different  classes  of  foodstuffs,  and  give  an  ex- 
ample of  each,     (b)  Name  a  perfect  food,  and  tell  why  so  called. 

2.  (a)  What  is  predigested  milk?  (b)  Modified  milk?  (c) 
Pasteurized  milk?     (d)  Certified  milk? 

3.  (a)  What  is  the  composition  of  w^ater?  (b)  Boiling  point 
and  freezing  point?  (c)  How  would  you  render  boiled  water  palat- 
able? (d)  How  boil  w^ater  for  tea?  (e)  Should  tea  be  an  infusion 
or  a  decoction? 

4.  Describe  the  process  of  making  (a)  Beef  Tea;  (b)  Beef  Juice. 

5.  (a)  Define  Chyme;  (b)  Chyle. 

6.  In  what  organs  and  by  what  enzymes  are  starches  digested? 

7.  Outline  the  daily  care  of  the  ice  box. 

8.  Give  breakfast,  dinner  and  supper  for  a  diabetic  patient. 

9.  Outline  a  diet  for  (a)  constipation;  (b)  diarrhea. 

10.  What  class  of  vegetables  is  rich  in  protein? 

11.  Give  five  (5)  ways  of  serving  milk  to  a  patient. 

12.  Give  brief  description  of  the  care  of  dishes  used  by  a  typhoid 
patient. 

September,  1914 

1.  Name  the  food  principles,  and  give  their  functions. 

2.  How  do  you  make  beef  broth?    How  do  you  make  beef  extract? 

3.  In  what  organs  and  by  what  enzymes  are  starches  digested? 

4.  (a)  Name  the  divisions  of  the  digestive  tract,  (b)  Mention 
three  (3)  enzymes,     (c)  Wliere  found  and  what  are  their  actions? 

5.  (a)  Name  three  diseases  requiring  special  diet,  (b)  Give 
proper  menu  for  one  meal  in  each  disease. 

6.  How  may  milk  be  contaminated? 

7.  Give  one  day's  bill-of-fare  for  a  tuberculous  patient  who  is  up 
and  about. 

8.  Would  you  make  tea  as  an  infusion  or  a  decoction? 

9.  Which  is  most  easily  digested:  a  raw,  soft,  medium,  or  hard 
boiled  egg? 


INTRODUCTION 


xxxvii 


10.  Give  a  wholesome  bill  of  fare  for  a  dinner  for  a  convalescent 
operative  patient,  and  name  the  food  principle  or  principles  in  each 
article  of  diet. 

11.  Give  five  (5)  ways  of  serving  milk. 

12.  What  change  is  produced  in  bread  by  toasting? 

NEBRASKA 
May,  1914 

1.  What  is  food?  What  is  meant  by  food  principles?  Name 
them,  give  their  functions  and  tell  the  chemical  they  contain. 

2.  What  is  a  calorie?  How  many  calories  in  a  gram  of  protein, 
fat,  carbohydrates?  How  many  calories  in  a  pound  of  protein,  fat, 
carbohydrates  ? 

3.  Explain  the  process  and  changes  that  take  place  in  the  diges- 
tion of  proteins,  carbohydrates  and  fats. 

4.  What  is  a  beverage?    Name  six  uses. 

5.  Explain  the  difference  between  plain,  certified,  pasteurized  and 
sterilized  milk. 

6.  Tell  how  you  would  prepare  a  cup  of  tea,  coffee  and  cocoa. 

7.  What  food  principle  is  to  be  guarded  against  in  the  diet  of  a 
diabetic?  Name  some  foods  that  may  be  given.  Name  some  foods 
that  should  not  be  given. 

8.  What  are  the  essential  points  in  cooking  starched  food?  How 
should  meat  be  cooked  in  order  to  retain  its  juices?  How  should 
meat  be  cooked  if  it  is  desired  to  extract  the  juices? 

9.  In  serving  food  to  the  sick,  name  five  principles  that  should 
govern  the  nurse. 

10.  Name  three  chief  purposes  of  cooking  food. 

11.  What  is  the  proper  way  to  boil  an  egg,  to  cook  rice,  to  make 
custard  and  make  junket  and  give  your  reason  for  so  doing? 

12.  In  preparing  a  meal  for  a  patient  in  a  home,  what  should 
be  the  nurse's  aim? 

NEW  JERSEY 
June,  1914 

1.  Why  are  drinks  made  from  fruit  juices  especially  valuable  for 
fever  patients? 

2.  Describe  the  process  of  making  beef  tea. 

3.  Name  four  uses  of  water  in  the  body,  and  the  value  of  milk 
as  a  food. 

4.  Name  three  diseases  requiring  special  diet.  Give  proper  menu 
for  one  meal  in  each  disease. 

5.  Which  is  most  easily  digested,  raw,  soft,  medium  or  hard 
boiled  eggs? 


xxxviii 


INTRODUCTION 


6.  Describe  the  care  of  milk. 

7.  What  disease  is  often  caused  by  impure  milk? 

NEW  YORK 
1907 

1.  What  effect  has  cooking  on  meat? 

2.  Give  recipe  for  veal  broth  made  from  a  half  pound  of  veal. 

3.  State  the  length  of  time  required  to  cook  properly  the  follow- 
ing cereals:  rolled  oats,  Irish  oatmeal,  steamed  rice,  cornmeal  mush. 

4.  How  would  you  make  a  flour  ball? 

5.  Give  recipe  for  making  an  oyster  stew  containing  a  pint 
of  oysters. 

6.  How  would  you  determine  whether  or  not  an  egg  is  fresh? 

7.  Which  is  more  quickly  digested,  a  raw  egg  or  a  soft-boiled 
egg  ?    Why  ? 

8.  Give  a  recipe  for  egg  sandwich. 

9.  Give  the  general  rules  for  making  custards. 

10.  How  would  you  bake  a  banana  and  prepare  it  for  a  patient? 

1908 

1.  Wliat  are  the  uses  of  water  in  the  body? 

2.  Name  three  vegetable  acids. 

3.  Give  three  examples  of  foods  in  which  starch  is  found. 

4.  Of  what  value  is  sugar  as  food? 

5.  Give  three  examples  of  food  containing  fat. 

6.  What  hygienic  effect  has  heat  on  milk? 

7.  How  should  an  egg  be  boiled?  How  should  it  be  served  to  an 
invalid  ? 

8.  How  would  you  make  a  raw  beef  sandwich? 

9.  Why  is  stale  bread  more  easily  digested  than  bread  freshly 
baked? 

10.  Give  recipe  for  lemon  jelly. 

11.  Outline  a  breakfast  for  a  convalescent  man. 

12.  Outline  a  dinner  for  a  convalescent  woman. 

13.  Give  recipe  for  creamy  rice  pudding. 

14.  Of  what  value  are  fruits  as  food? 

15.  What  are  the  requirements  of  food  for  a  fever  patient  in  order 
that  proper  nourishment  may  be  obtained? 

1909 

1.  What  is  meant  by  predigested  food? 

2.  What  effect  on  the  system  has  hot  water  when  taken  internally? 

3.  What  effect  has  sterilization  on  milk? 

4.  What  is  condensed  milk?    State  its  value  as  a  food. 


INTRODUCTION 


xxxix 


5.  How  is  limewater  made? 

6.  What  is  farinaceous  diet? 

7.  What  are  the  most  important  food  products  derived  from  the 
vegetable  kingdom? 

8.  State  the  effect  of  coffee  on  the  system. 

9.  What  are  concentrated  foods  ?    State  their  chief  use. 

10.  State  the  food  value  of  green  vegetables. 

11.  What  are  the  diet  requirements  in  anaemia? 

12.  Mention  some  factors,  apart  from  proper  diet,  that  specially 
affect  the  digestion. 

13.  Name  some  diseases  that  may  be  caused  by  the  following  errors 
in  diet:  (a)  insufficient  food;  (b)  overeating;  (c)  lack  of  fresh 
food;  (d)  improperly  balanced  diet. 

14.  What  are  the  reasons  for  limiting  the  diet  of  a  young  child  to 
certain  foods? 

15.  What  changes  in  diet  should  be  made  in  advanced  years? 
Why? 

February,  1911 

1.  Why  should  the  nurse  have  a  working  knowledge  of  dietetics? 

2.  Classify  the  food  principles  as  (a)  organic  or  inorganic,  (&) 
nitrogenous  or  non-nitrogenous. 

3.  Explain  w^hy  carbohydrates  alone  are  not  sufficient  for  a 
dietary. 

4.  Name  the  digestive  ferments  and  give  their  functions. 

5.  Describe  in  detail  the  proper  care  of  milk  from  the  time  it  is 
drawn  till  it  is  used. 

6.  Compare  the  advantages  and  the  disadvantages  of  sterilized 
milk  with  those  of  pasteurized  milk. 

7.  Trace  the  digestion  of  a  glass  of  milk. 

8.  State  why  it  is  important  for  a  convalescent  typhoid  patient 
to  resume  solid  food  gradually. 

9.  What  diet  would  you  give  to  an  anaemic  patient,  if  the  matter 
w^ere  left  to  your  discretion? 

10.  What  is  the  effect  of  heat  on  (a)  starch,  (6)  albumin? 

11.  What  is  cellulose  and  what  is  its  value? 

12.  What  is  the  disadvantage  of  boiled  water  and  how  may  this 
disadvantage  be  overcome? 

13.  Give  four  points  to  be  considered  in  the  preparation  of  an 
invalid's  tray. 

14.  Give  concisely  the  ingredients  and  the  method  of  preparation 
of  (a)  beef  tea,  (&)  oatmeal  gruel. 

15.  Why  is  it  best  to  surround  the  cups  with  cold  water  when 
putting  custards  in  to  bake? 


xl 


INTRODUCTION 


June,  1911 

1.  State  the  uses  of  food. 

2.  What  processes  are  necessary  to  make  food  of  use  to  the 
body? 

3.  What  is  the  object  of  the  digestion  of  food? 

4.  What  food  principles  require  digestion? 

5.  Name  two  vegetables  containing  a  good  proportion  of  proteid. 

6.  Name  two  vegetables  containing  a  large  proportion  of  carbo- 
hydrate. 

7.  Name  two  vegetables  containing  a  large  amount  of  salts. 

8.  Why  are  fruits  a  valuable  addition  to  a  general  diet? 

9.  What  food  principle  predominates  in  nuts? 

10.  Why  are  meats  restricted  or  forbidden  in  cases  of  nephritis? 

11.  Why  are  carbohydrates  restricted  in  cases  of  diabetes? 

12.  Why  is  a  salt-free  diet  often  ordered  in  illness  when  there  is 
edema? 

13.  Why  are  meats  more  digestible  when  broiled  or  roasted  than 
when  fried? 

14.  Give  the  method  of  making  chicken  broth. 

15.  Mention  two  ways  of  removing  fat  from  a  soup. 

February,  1912 

1.  In  what  places  and  under  what  names  is  food  stored  in  the 
body? 

2.  Give  the  mechanical  processes  of  digestion. 

3.  Of  what  elements  is  proteid  food  composed? 

4.  In  health  what  are  the  advantages  of  drinking  large  quantities 
of  water? 

5.  Outline  for  a  nephritic  patient  the  three  meals  for  one  day. 

6.  What  is  (a)  chyme,  (5)  chyle? 

7.  What  are  the  uses  of  condiments? 

8.  Why  is  table  salt  an  essential  part  of  our  diet? 

9.  What  is  a  calorie? 

10.  W^hat  articles  of  food  would  you  avoid  giving  to  a  rheumatic 
patient? 

11.  What  vegetables  and  fruits  would  you  give  to  a  patient  with 
a  tendency  to  constipation?  Why? 

12.  What  food  principle  is  lacking  in  eggs? 

13.  Explain  briefly  the  process  used  in  raising  and  baking  bread.  ^ 

14.  How  would  you  make  and  serve  toast  in  order  to  increase  its 
digestibility? 

15.  Describe  the  process  of  making  tea,  giving  reasons  for  this 
process. 


INTRODUCTION 


xli 


June,  1912 

1.  What  is  a  mixed  diet?    What  are  its  advantages  in  health? 

2.  Why  is  fresh  air  necessary  to  nutrition? 

3.  What  may  be  used  as  a  substitute  for  sugar  in  cases  where 
carbohydrate  food  is  limited? 

4.  Mention  four  chief  sources  of  fat  in  the  diet. 

5.  W^hich  is  the  more  easily  digested,  fat  or  carbohydrate  food? 

6.  What  is  distilled  water?  Why  is  it  unsuitable  for  use  as  a 
beverage  ? 

7.  Why  is  salt  used  with  ice  in  freezing  ice  cream? 

8.  What  is  buttermilk?    What  are  its  uses? 

9.  Mention  tico  signs  that  indicate  that  an  egg  is  fresh. 

10.  What  kinds  of  food  would  you  give  in  cases  of  diarrhea? 

11.  What  kinds  of  food  would  you  give  in  cases  of  constipation? 

12.  What  is  broiling?    What  are  its  advantages  over  frying? 

13.  How  would  you  peptonize  a  pint  of  milk  by  the  cold  process? 

14.  Tell  how  you  would  prepare  and  serve  raw  beef  sandwiches. 

15.  Describe  briefly  the  necessary  steps  in  making  mutton  broth. 

January,  1913 

1.  Name  three  juices  in  the  body  that  aid  digestion. 

2.  W^hy  do  water  and  mineral  salts  not  require  digestion? 

3.  What  is  digestion? 

4.  What  is  the  name  of  the  special  substance  in  any  digestive 
juice,  which  brings  about  chemical  changes  in  the  food? 

5.  Where  in  the  body  does  the  oxidation  of  food  take  place? 

6.  What  is  meant  by  the  caloric  value  of  food? 

7.  W^hat  special  value  has  proteid  food? 

8.  Name  the  ferments  in  the  pancreatic  juice. 

9.  Outline  three  meals  for  a  patient  with  chronic  constipation. 

10.  Why  is  it  now  considered  desirable  not  to  restrict  the  diet  in 
typhoid  fever  to  fluids  only? 

11.  What  may  be  the  advantage  of  giving  eggs  raw  in  cases  of 
tuberculosis? 

12.  How  may  hard  drinking  water  generally  be  rendered  soft? 

13.  Why  should  potatoes  be  thoroughly  cooked? 

14.  Tell  how  you  would  make  and  serve  oatmeal  gruel. 

15.  Tell  how  you  would  cream  oysters  for  one  person. 

June,  1913 

1.  Define  (a)  chyme,  (&)  chyle. 

2.  At  what  age  may  a  healthy  child  begin  to  digest  starches? 

3.  In  what  organs  and  by  what  enzymes  are  starches  digested? 

4.  Mention  three  results  gained  by  the  cooking  of  food. 


xlii 


INTRODUCTION 


5.  Give  the  freezing  and  the  boiling  point  of  (a)  the  Fahrenheit 
thermometer,  (&)  the  centigrade  thermometer. 

0.  Make  a  list  of  five  tissue-building  foods. 

7.  What  does  the  term  "top  milk"  mean? 

8.  When  10%  top  milk  is  used,  what  is  the  relative  proportion 
o?  fat  to  proteid? 

9.  Outline  the  daily  care  of  an  ice  box. 

10.  Contrast  the  cooking  of  meat  in  making  broth  and  in  broiling. 

11.  Describe  the  care  of  milk  in  the  home.  Give  reasons  for  your 
answer. 

12.  How  would  you  make  junket?    State  the  source  of  rennet. 

13.  Give  the  general  rule  for' making  cream  vegetable  soups. 

14.  Tell  how  you  would  make  cocoa  and  give  your  reasons  for 
thus  making  it. 

15.  Name  tico  diseases  in  which  carbohydrate  food  is  limited. 

January,  1914 

1.  To  what  classes  do  the  following  foods  belong:  (a)  beef,  (&) 
potatoes,  (c)  eggs,  {d)  lettuce,  (e)  butter? 

2.  What  digestive  juices  are  involved  in  the  digestion  of  each 
of  the  above  foods? 

3.  Name  three  kinds  of  food  that  should  in  general  be  eliminated 
from  the  diet  of  the  sick. 

4.  What  is  tlie  difference  between  cocoa  and  chocolate? 

5.  Why  is  human  milk  more  easily  digested  than  cow's  milk? 

6.  Give  the  relative  per  cent,  of  fat  and  proteid  in  7%  top  milk. 

7.  Give  menus  for  three  meals,  with  a  special  view  to  increasing 
bodily  weight  in  a  person  who  is  otherwise  healthy. 

8.  W^hat  is  the  chief  dietary  value  of  fruits? 

9.  Of  w^iat  food  value  are  salads? 

10.  What  foods  do  you  eliminate  in  cases  of  diabetes?  in  cases  of 
nephritis? 

11.  How  would  you  cook  rice  for  an  invalid? 

12.  Give  your  method  of  baking  apples. 

13.  Mention  three  ways  of  cooking  eggs,  suitable  for  a  patient  on 
a  soft  diet. 

14.  What  kinds  of  food  would  you  give  in  cases  of  rachitis? 

15.  \Vliat  diet  in  general  would  you  follow  in  nursing  patients 
with  nervous  disorders? 

June,  1914 

1.  What  is  the  object  of  the  digestion  of  food? 

2.  How  do  carbohydrates  and  fats  differ  in  their  food  values? 

3.  Where  does  the  absorption  of  food  chiefly  take  place? 

4.  Name  the  cliief  ingredients  of  gastric  juice. 


INTRODUCTION 


xliii 


5.  What  takes  place  in  stomach  digestion? 

6.  Name  two  mollusks  and  two  crustaceans  used  for  food. 

7.  State  two  methods  of  preserving  food  and  illustrate  each. 

8.  What  are  the  advantages  of  a  double  boiler? 

9.  In  mixing  ingredients  what  is  the  difference  between  stirring 
and  beating? 

10.  Mention  three  points  to  consider  in  making  out  a  menu. 

11.  How^  would  you  roast  a  piece  of  beef? 

12.  Describe  your  method  of  making  an  omelet. 

13.  How  would  you  make  a  fruit  salad? 

14.  Why  are  fluids  given  in  most  fevers? 

15.  Why  is  diet  so  important  in  nursing  tuberculosis? 

NORTH  CAROLINA 
1908 

1.  In  what  foods  are  ptomaine  poisoning  most  likely  to  be 
found?    How  may  this  be  avoided? 

2.  W^hat  can  you  say  of  the  effect  of  long  or  second  cooking  of 
albuminous  foods?  State  whether  or  not  this  increases  their  di- 
gestibility. 

3.  Give  a  list  of  the  easily  digested  meats,  (a)  Describe  method 
of  cooking  one  of  these,  (b)  Name  those  you  would  not  give  an 
invalid,  giving  reasons. 

4.  Give  a  list  of  foods  you  have  been  accustomed  to  giving  con- 
valescents from  typhoid  fever,  between  the  liquid  and  full  diet  period. 

5.  What  foods  have  you  given  your  obstetrical  cases  during  the 
first  two  weeks? 

6.  When  is  a  healthy  child  considered  able  to  digest  starchy 
foods  ? 

7.  Name  such  foods  as  you  would  give  a  healthy  child  from  12 
to  18  months  of  age. 

8.  What  vegetables  supply  about  the  same  elements  for  the  sys- 
tem as  meats? 

9.  What  can  you  say  of  the  long  and  second  cooking  of  starchy 
foods  ? 

10.  Name  such  vegetables  and  fruits  as  you  would  give  an  invalid. 
State  reasons. 

1909 

1.  Give  theory  of  cooking  starches  and  tell  where  and  by  what 
digested. 

2.  Name  the  cereals  that  require  long  cooking  and  give  approxi- 
mate time. 

3.  Why  do  we  toast  bread? 


xliv 


INTRODUCTION 


4.  What  disease  is  usually  given  a  carbohydrate-free  diet? 

5.  Name  the  heat  and  energy-giving  foods. 

6.  What  do  you  consider  an  ideal  diet? 

7.  What  should  be  the  characteristics  of  an  invalid's  dietf 

8.  What  are  some  of  the  advantages  of  vegetables  and  fruits  in 
our  own  diet? 

9.  Why  is  cow's  milk  more  likely  to  disagree  with  infants  during 
the  summer  than  in  cold  weather? 

10.  Up  to  the  present  have  we  been  benefited  by  the  pure  food 
laws? 

11.  Which  contains  more  nourishment,  foi  of  beef  juice  or  fji  of 
beef  tea? 

12.  Give  a  list  of  tissue-building  foods. 

13.  What  should  be  the  diet  of  a  case  of  acute  nephritis?  (6) 
A  case  of  eclampsia  preceding  or  following  labor? 

14.  Give  several  ways  in  which  milk  and  eggs  may  be  prepared 
and  flavored  to  give  variety  to  liquid  diet. 

15.  State  some  of  the  advantages  and  disadvantages  of  milk,  as 
a  food  for  invalids. 

June,  1912 

1.  Name  the  different  sources  of  foods. 

2.  From  what  source  do  we  have  (a)  Proteids,  (b)  Carbohydrates, 
(c)  Salts. 

3.  What  elements  do  the  different  classes  supply  to  the  body  — 
(a)  Proteids,  (b)  Carbohydrates,  (c)  Salts. 

4.  What  is  the  relative  value  of  skimmed  and  unskimmed  milk, 
and  why? 

5.  What  important  function  does  water  perform  in  the  body? 

6.  Mention  some  points  to  be  remembered  in  serving  food  to  pa- 
tients. 

7.  Which  is  preferable,  to  serve  too  little  or  an  overabundance  to 
a  patient,  and  why? 

8.  If  you  were  doing  private  nursing  and  could  not  get  ice,  how 
would  you  keep  eggs  and  milk  fresh? 

9.  Name  several  ways  of  cooking  eggs  for  invalids. 
10.  Give  directions  for  making  whey. 

November,  1912 

1.  (a)  Define  foodstuffs,    (b)  What  are  the  uses  of  food? 

2:  (a)  What  causes  milk  to  sour?  (b)  What  preventive  meas- 
ures can  be  used  to  keep  milk  from  becoming  sour? 

3.  Describe  six  ways  of  preparing  milk  and  eggs,  either  separately 
or  together,  with  which  to  vary  a  liquid  diet. 


INTRODUCTION 


xlv 


4.  What  classes  of  foodstuffs  should  be  excluded  from  a  rheu- 
matic diet,  and  why? 

5.  (a)  Give  the  theory  of  cooking  starch,  (b)  What  secretions 
assist  in  the  digestion  of  starches? 

"6.  Mention  some  diseases  in  which  the  diet  forms  an  important 
part  in  the  treatment  of  disease,  or  in  which  errors  in  diet  may 
have  serious  consequences. 

7.  What  foods  are  excluded  from  a  diabetic  diet?  and  give  the 
substitutes. 

8.  (a)  Why  is  the  diet  of  such  importance  in  the  treatment  of 
tuberculosis?     (b)  Of  what  foods  does  the  diet  chiefly  consist? 

9.  Why  is  thorough  cooking  of  cereal  foods  especially  important? 
10.  (a)  What  is  a  Calorie?    (b)  How  many  Calories  required 

daily  by  an  adult? 

May,  1914 

1.  Give  the  meaning  of  digestion. 

2.  What  are  the  three  values  of  food  to  the  body? 

3.  How  many  Calories  of  food  are  necessary  for  an  adult  in  24 
hours? 

4.  How  can  foods  be  divided  into  five  classes? 

5.  Give  diet  for  a  typhoid  fever  patient.    Acute  nephritis. 

6.  What  are  nitrogenous  foods? 

7.  Give  breakfast,  dinner  and  supper  for  a  diabetic  patient. 

8.  What  is  the  relative  value  of  starches,  proteids,  and  fats? 

9.  Where  does  the  digestion  of  above  occur? 

NEW  HAMPSHIRE 
May,  1911 

1.  Of  what  value  is  food  to  the  human  body? 

2.  What  is  the  average  composition  of  cow's  milk?  Mother's 
milk? 

3.  State  in  detail  a  method  of  peptonizing  milk. 

4.  Why  are  different  foods  cooked? 

51  What  should  be  the  diet  of  a  tubercular  patient  in  the  incipient 
stage  ? 

6.  What  is  the  usual  form  of  diet  in  acute  gastritis? 

7.  What  foods  should  be  avoided  if  there  is  a  tendency  to  flatu- 
lency ? 

8.  What  should  be  the  general  diet  in  diseases  of  the  heart? 

9.  What  class  of  foods  is  to  be  avoided  in  diabetes  mellitus? 
10.  Give  in  detail  a  day's  diet  for  a  diabetic  patient. 


xlvi 


INTRODUCTION 


October,  1911 

1.  Compare  mother's  and  cow's  milk. 

2.  What  are  nitrogenous  foods? 

3.  What  foods  can  be  given  a  patient  with  diabetes?    Give  a 
breakfast,  dinner  and  supper  for  such  a  patient. 

4.  Of  what  value  is  beef  broth  as  a  food? 

5.  Give  a  detailed  method  of  making  baked  custards  for  the  sick. 
G.  W^hat  should  be  the  diet  of  an  habitually  constipated  person? 

7.  Give  in  detail  the  diet  of  a  typhoid  patient  from  the  beginning 
to  the  termination  of  the  disease. 

8.  How    would    you    make    corn-meal    gruel?    Oyster  stew? 
Chicken  broth? 

\).  What  is  the  diet  in  acute  nephritis? 
10.  How  would  you  prepare  a  steak?    A  chop? 

April,  1912 

1.  Name  the  chief  classes  of  food. 

2.  When  should  water  be  boiled  and  why? 

3.  What  value  has  nitrogenous  food? 

4.  State  in  detail  the  preparation  of  egg-albumin  for  a  typhoid 
patient. 

5.  State  in  detail  how  you  would  make  chicken  broth. 

G.  Give  a  breakfast,  dinner  and  supper  diet  for  diabetes  mellitus. 

7.  How  would  you  make  an  egg-nog?  tea?  coffee? 

8.  How  would  you  prepare  and  serve  a  steak?  a  chop? 

9.  What  is  milk?    Name  four  milk  products. 
10.  How  w^ould  you  peptonize  milk? 

October,  1913 

1.  How  would  you  cook  a  steak?    A  chop?    What  are  the  ad- 
vantages of  your  method  of  cooking  over  other  methods? 

2.  How  long  would  you  cook  a  cereal?  Why? 

3.  How  would  you  make  a  cup  of  coffee?    Of  tea? 

4.  Give  a  diabetic  breakfast,  dinner  and  supper  in  detail. 

5.  What  is  a  proper  diet  to  give  in  acute  Bright's  disease? 
G.  Of  what  value  are  the  meat  broths  as  foods? 

7.  What  is  the  use  of  the  Pure  Food  Laws?    What  is  food  adul- 
teration? # 

8.  How  may  foods  be  classified? 

9.  State  in  detail  a  method  of  peptonizing  milk? 
10.  Of  what  value  is  milk  as  a  food? 

April,  1914 

1.  What  is  food? 

2.  What  are  the  special  functions  of  proteids,  fats,  carbohydrates  ? 


INTRODUCTION 


xlvii 


3.  Why  is  a  mixed  diet  necessary? 

4.  What  is  absorption? 

5.  What  is  the  relative  food  value  of  starches,  proteids  and  fats? 

6.  What  do  you  understand  as  the  caloric  unit? 

7.  Describe  the  usual  diabetic  diet? 

8.  What  is  pasteurized  milk? 

9.  Describe  the  proper  method  of  preparing  toast  for  a  patient. 
10.  What  articles  of  food  are  to  be  especially  avoided  in  nephritis? 

October,  1914 

1.  Why  is  food  necessary  for  the  maintenance  of  the  body? 

2.  How  are  foods  classified  according  to  their  chemical  compo- 
sition ? 

3.  What  is  the  chief  source  of  proteid  food? 

4.  Give  ingredients  of  two  nutritive  enemata. 

5.  What  are  the  principal  reasons  for  cooking  food? 

6.  State  correct  method  of  preparing  tea,  coffee,  lemonade,  and 
malted  milk. 

7.  State  in  detail  how  to  cook  and  serve  a  steak,  a  chop,  and  a 
piece  of  bacon. 

8.  Give  one  day's  dietary  for  a  patient  having  diabetes  mellitus. 

9.  Compare  mother's  and  cow's  milk. 

10.  Describe  two  methods  of  peptonising  milk. 

OKLAHOMA 
October,  1912 

1.  Give  definition  of  food. 

2.  Why  is  a  mixed  diet  necessary  as  an  ideal  diet? 

3.  Describe  the  gradual  effect  of  heat  on  the  white  of  an  egg. 
(Albumin.) 

4.  How  sliould  an  egg  be  boiled  and  served  to  an  invalid? 

5.  How  would  you  make  and  serve  toast  to  increase  its  digesti- 
bility? 

6.  What  do  you  consider  an  ideal  typhoid  diet? 

7.  Why  is  cow's  milk  more  likely  to  disagree  with  an  infant  dur- 
ing summer  than  in  cold  weather? 

8.  What  is  important  in  the  cooking  of  starchy  foods? 

9.  Give  diet  for  obstetrical  patient  during  first  week. 
10.  Give  one  good  nutritive  enema. 

June,  1913 

1.  Give  source  of  food. 

2.  What  are  the  chemical  classification  of  foods? 

3.  Name  five  important  sources  of  proteins. 


xlviii 


INTRODUCTION 


4.  Give  the  functions  of  carbohydrates. 

5.  What  one  liquid  food  contains  the  most  nutriment? 

6.  In  the  absence  of  specific  directions  what  would  you  give  a 
fever  patient? 

7.  Give  a  test  breakfast. 

8.  What  would  you  avoid  in  a  diabetic  diet? 

9.  How  would  you  make  a  lemon  albumin?    An  egg  nog? 
10.  Give  points  to  be  observed  in  setting  an  invalid's  tray. 

October,  1913 

1.  Give  source  of  food. 

2.  Give  definition  of  a  perfect  food. 

3.  Why  do  you  consider  a  mixed  diet  advisable? 

4.  Why  are  fruits  a  valuable  addition  to  a  general  diet? 

5.  Describe  the  proper  method  of  preparing  toast,  coffee,  and  beef- 
steak for  an  invalid. 

6.  How  should  starchy  foods  be  cooked. 

7.  How  would  you  prepare  beef  juice  and  how  many  ounces  would 
you  expect  from  one  pound  of  beef? 

8.  What  fluid  food  contains  the  most  nutriment? 

9.  Which  is  the  more  quickly  digested,  a  raw  egg  or  a  soft 
boiled  egg,  and  why? 

10.  What  would  you  give  a  typhoid  fever  case  between  liquid  and 
light  diet? 

June,  1914 

1.  Define  foods. 

2.  What  are  the  chemical  classifications  of  foods? 

3.  What  do  you  understand  by  proteins? 

4.  What  constitutes  a  perfect  food? 

5.  (a)  Give  some  of  the  chief  tissue  building  foods,  (b)  Give 
some  of  the  heat  producing  foods. 

6.  Name  some  of  the  vegetables  containing  little  or  no  starch 
and  give  reason  why  they  are  essential  to  health. 

7.  How  would  you  cook  potatoes  for  an  invalid  to  have  them 
most  easily  digested? 

8.  Name  two  beverages  which  contain  tannin  and  tell  how  it 
is  extracted. 

9.  Why  is  milk  of  especial  value  as  a  food  for  an  invalid?  Give 
reasons  why  it  is  not  a  perfect  food  for  a  healthy  adult. 

10.  What  is  lactose  and  where  found? 

October,  1914 

1.  Name  the  different  classes  into  which  foods  may  be  divided. 

2.  Classify:   (a)  Sugar,     (b)  Butter,     (c)  Milk,     (d)  Eggs. 


INTRODUCTION 


xlix 


3.  What  would  you  include  in  a  (a)  liquid  diet?    (b)  soft  diet? 

4.  What  are  the  chief  ingredients  in  fruits? 

5.  Give  list  of  tissue  building  foods. 

6.  What  disease  is  usually  given  a  carbohydrate  free  diet? 

7.  How  would  you  make  beef  tea? 

8.  What  would  you  include  in  a  diet  for  a  patient  suffering  from 
Bright's  Disease? 

9.  Give  one  method  of  predigesting  milk. 

10.  How  ought  beef,  chicken  and  fish  to  appear  when  in  a  healthy 
condition? 

TEXAS 
November,  1912 

1.  Name  the  different  classes  into  which  food  may  be  divided. 

2.  How  would  you  make  beef  broth?    Beef  juice? 

3.  What  class  of  foods  should  be  excluded  from  a  rheumatic  diet 
and  why? 

4.  Name  three  foodstuffs  rich  in  albumin. 

5.  Give  a  general  outline  of  diet  for  a  typhoid  fever  patient. 
One  for  a  diabetic  patient. 

6.  Give  a  list  of  fruits  to  be  recommended  for  laxative  effect. 

7.  Why  is  a  mixed  diet  necessary?  v 

8.  What  effect  does  boiling  have  upon  tea? 

9.  Why  is  thorough  cooking  especially  important  in  cereal  foods? 
10.  Give  points  to  be  observed  in  setting  an  invalid's  tray. 

1913 

1.  Give  menu  for  first  week  of  typhoid  convalescent. 

2.  Diet  during  puerperium, 

3.  What  are  the  chief  ingredients  in  fruits? 

4.  State  the  food  value  of  green  vegetables. 

5.  Name  some  diseases  that  may  be  caused  by  errors  in  diet,  (a) 
Insufficient  food,     (b)  Overeating,     (c)  Lack  of  fresh  food. 

6.  What  is  meant  by  predigested  food? 

7.  What  effect  has  coffee  on  the  system? 

8.  Mention  one  good  nutritive  enema. 

9.  If  you  wish  to  keep  the  juice  in  meat  how  do  you  cook  it? 
10.  What  foods  contain  the  most  albumin? 

1914 

1.  Name  the  different  classes  into  which  food  may  be  divided. 

2.  What  useful  function  is  performed  by  the  indigestible  part  of 
vegetables  ? 

3.  Give  a  list  of  fruits  to  be  recommended  for  laxative  effects. 


1 


INTRODUCTION 


4.  Give  receipt  for  egg-nog;  lemon  albumin. 

5.  Which  is  n^ore  easily  digested,  a  raw  egg  or  a  soft  boiled 
egg?  Why? 

6.  Give  menu  for  the  first  week  of  typhoid  convalescent. 

7.  Give  diet  during  puerperium. 

8.  If  you  wish  to  keep  juice  in  meat,  how  do  you  cook  it? 

9.  What  is  meant  by  predigested  food? 

10.  Mention  one  good  nutritive  enema. 

11.  What  foods  contain  the  most  albumin? 

Answer  eight  questions. 

VIRGINIA 
December,  1911 

1.  Name  the  principal  chemical  elements  contained  in  the  human 
body. 

2.  Wliy  is  a  mixed  diet  necessary? 

3.  How  would  you  prepare  beef  juice?  How  much  juice  will  one 
pound  of  beef  make? 

4.  Give  examples  of  liquid  and  soft  diet. 

5.  What  would  you  give  a  typhoid  patient  when  he  is  first  al- 
lowed solid  food? 

0.  What  point  should  always  be  observed  in  cooking  cereals? 
Mention  a  complete  food. 

January,  1913 

1.  What  are  the  uses  of  food? 

2.  Name  the  two  common  classifications  of  food? 

3.  Name  the  digestive  juices. 

4.  Why  is  milk  called  perfect  food. 

5.  What  are  sweetbreads? 

6.  What  is  meant  by  the  modification  of  milk? 

7.  Mention  some  diseases  in  which  the  diet  forms  an  important 
part  of  the  treatment,  or  in  which  errors  of  diet  may  have  serious 
consequences  ? 

8.  What  foods  should  be  avoided  in  rheumatism? 

9.  What  foods  are  of  special  importance  in  treating  scurvey? 

10.  What  are  some  of  the  uses  of  water  in  the  body?  z 

July,  1913 

1.  What  is  the  object  of  the  digestion  of  food? 

2.  What  is  important  in  the  cooking  of  starchy  foods? 

3.  Why  are  carbohydrates  restricted  in  cases  of  diabetes? 

4.  What  must  be  done  to  milk  immediately  upon  removal  from 
the  fire?  Why? 


INTRODUCTION 


li 


5.  What  is  the  principal  point  to  be  remembered  in  cooking  eggs? 

6.  What  cut  of  beef  is  best  for  beef  tea,  and  why? 

7.  How  should  potatoes  be  cooked  to  avoid  loss  of  starch  and 
salt? 

8.  Mention  some  points  that  should  be  remembered  when  serving 
food  to  a  patient. 

9.  Xame  two  vegetables  containing  a  good  proportion  of  pro- 
teid. 

10.  Give  the  method  of  making  chicken  brOth. 

January,  1914 

1.  (a)  What  are  the  uses  of  food?  (b)  What  is  meant  by  a 
calorie? 

2.  (a)  Name  three  sources  of  food,  (b)  Give  two  sources  each 
of  fats,  proteids  and  carbohydrates. 

3.  Show  why  a  mixed  diet  is  advisable. 

4.  (a)  Which  is  more  quickly  digested,  a  raw  egg  or  a  soft  boiled 
one?  (b)  Why?  (c)  How  should  an  egg  be  soft  boiled  and  served 
to  an  individual? 

5.  Give  a  list  of  fruits  to  be  recommended  for  their  laxative  ef- 
fects. 

6.  In  what  way  does  the  serving  of  food  affect  digestion? 

July,  1914 

1.  (a)  Name  three  foods  we  get  our  proteins  from;  (b)  three 
carbohydrates;  (c)  three  fats. 

2.  (a)  What  do  the  proteins  supply  our  body  with?  (b)  Car- 
bohydrates?    (c)  Fats?     (d)  Mineral  matter?     (e)  Water? 

3.  What  is  modified  milk?  (b)  What  utensils  would  you  have 
and  how  would  you  proceed  to  modify  milk?  (c)  How  do  you  get 
"top  milk"? 

4.  (a)  Give  some  of  the  foods  you  would  give  a  chronic  diabetie 
patient,    (b)  Some  you  would  avoid. 

5.  (a)  Give  a  typical  light  diet;  (b)  soft  diet;  (e)  full  diet. 

6.  (a)  How  do  you  make  a  cup  of  tea?  (b)  Coffee?  (c) 
Cocoa?    (d)  Albumin? 

7.  Give  recipe  for  making  soft  batter  bread. 

WASHINGTON 
1909 

1.  State  the  length  of  time  required  to  properly  cook  the  follow- 
ing cereals:  rolled  oats,  rice,  cornmeal  mush. 

2.  Of  what  value  are  fruits  in  digestion? 


lii 


INTRODUCTION 


3.  How  should  an  egg  be  boiled?  How  should  it  be  served  to  an 
invalid? 

4.  How  would  you  make  a  raw  beef  sandwich? 

5.  What  are  the  requirements  of  food  for  a  fever  patient  in  order 
that  the  proper  nourishment  may  be  obtained? 

6.  Why  is  stale  bread  more  easily  digested  than  bread  freshly 
baked? 

7.  What  is  meant  by  predigested  food? 

8.  How  would  you  prepare  extract  of  beef  from  the  raw  beef? 

9.  Briefly  outline  a  diet  for  diabetics. 

10.  Would  you  boil  cocoa?    Give  reasons  for  your  answer. 

1910 

1.  How  would  you  prepare  a  beefsteak?  Give  reasons  for  method 
employed. 

2.  Why  is  the  saliva  an  important  factor  in  the  digestive  process? 

3.  If  you  wish  to  keep  the  juice  in  meat,  how  do  you  cook  it? 

4.  Name  one  good  nutritive  enema. 

5.  What  is  important  in  cooking  starchy  foods? 

6.  What  would  you  include  in  a  soft  diet  for  an  invalid? 

7.  Briefly  outline  a  diet  for  a  patient  suffering  from  pulmonary 
tuberculosis. 

8.  What  are  the  diet  requirements  in  a  case  of  anaemia? 

9.  What  class  of  foods  should  be  excluded  from  a  rheumatic  diet 
and  why? 

10.  How  do  you  prepare  an  egg  omelet?    Coffee?    Cocoa?  Tea? 

June,  1913 

1.  Name  the  uses  of  water  in  the  body. 

2.  What  are  the  special  functions  of  the  following  food  princi- 
pals?   (a)  Proteins,     (b)   Fats,     (c)  Carbohydrates. 

3.  What  constitutes  a  perfect  food? 

4.  Give  formula  for  modifying  milk  for  infant  feeding  and  your 
reasons  for  the  need  of  modifying. 

5.  Give  in  detail  the  precautions  you  would  take  to  keep  certified 
milk  pure. 

6.  How  is  milk  pasteurized?  ^ 

7.  Name  several  articles  of  food  in  which  iron  is  available. 

8.  What  general  rules  should  be  observed  in  the  care  and  cooking 
of  cereals? 

9.  Of  what  value  are  fruit  juices? 

10.  Give  dietetic  treatment  in  acute  rheumatism. 

11.  State  briefly  what  instruction  you  have  had  in  Dietetics. 


INTRODUCTION 


liii 


June,  1914 

1.  Mention  five  (5)  chemical  elements  in  the  human  body,  and  tell 
how  they  are  supplied  to  the  body. 

2.  Give  sources  of  (a)  proteins;  (b)  carbohydrates;  (c)  fats; 
(d)  mineral  matters;  (e)  water. 

3.  What  is  waste  material?  Has  it  any  use  in  the  process  of 
digestion?    If  so,  what? 

4.  (a)  What  care  should  be  given  to  refrigerators,  cupboards, 
and  where  food  is  kept?  (b)  Give  in  detail  the  proper  care  of  food 
before  cooking. 

5.  Define  six  (6)  of  the  following:  (a)  boiling;  (b)  stewing; 
(c)  steaming;  (d)  f ricasseeing ;  (e)  baking;  (f)  roasting;  (g)  fry- 
ing;  (h)  broiling;   (i)  pan-broiling;   (j)  braizing. 

6.  Tell  in  detail  how  you  would  choose,  cook,  and  serve  a  beef- 
steak to  your  patient. 

7.  (a)  What  can  you  say  of  the  food  value  of  fish?  Mention  four 
(4)  methods  of  cooking  the  same. 

8.  (a)  What  do  you  understand  by  a  perfect  food?  (b)  What 
product  in  nature  is  provided  solely  for  food? 

9.  Could  the  body  subsist  on  concentrated  foods  alone?  Give 
reason  for  your  answer. 

10.  What  articles  of  diet  do  you  favor,  and  what  avoid  for  a  per- 
son who  is  habitually  constipated? 


CONTENTS 


PAGE 

Intkoduction  xiii 

The  American  Hospital  Association  —  Colorado  — 
Illinois  —  Minnesota  —  New  York  State  Board  Re- 
quirements in  Dietetics. 

PAET  I 

PEINCIPLES  OF  NUTEITIOJ^  AND  FOOD 
PEEPAEATION 

CHAPTER 

I    Food  3 

General  Object  —  Definition  —  Food  Accessories  (or 
Food  Adjuncts)  — Source  —  Composition  of  the  Body 

—  Composition  of  Food  —  Classification  of  Food  — 
Nitrogenous,  Protein  and  Extractives  —  Non-Nitro- 
genous, Carbohydrates  ( Starch  and  Sugar ) ,  Fats  — 
Water  —  Mineral  Matter.  Food  Accessories  —  Condi- 
tions for  Perfect  Nutrition. 

II   Nutrition  36 

Digestion:  —  Protein  —  Fats  —  Carbohydrates  — 
Mineral  Matter  —  Water.  Resume  of  Digestion  — 
Factors  Determining  Rate  of  Digestion.    Absorption  : 

—  Protein  —  Fats  —  Carbohydrates  —  Mineral  Matter 

—  Water.     Metabolism  :  —  Protein  —  Fats  —  Carbo- 
hydrates. Excretion. 

III  Food  Values  54 

The  Balance  of  Energy  and  Nitrogen  Equilibrium, 
The  Energy  Value  of  Food  —  Energy  Requirements  of 
the  Body  —  Tables  Showing  the  Nutritive  Value  of 
Food. 

IV  Feeding  the  Sick   .  72 

General  Rules  —  Physicians'  Directions  —  Feeding 

LV 


CONTENTS 


PAGE 


in  Acute  Disease  —  Evidences  of  Digestion  —  The  Ap- 
petite—  Punctuality  in  Serving  —  Quality  and  Quan- 
tity of  Food  —  Temperature  of  Food  —  Details  in 
Feeding  —  Bathing  and  Cleansing  the  Mouth  —  Time 
and  Position  for  Feeding  —  Sleep  and  Feeding  — 
Feeding  the  Helpless  Patient  —  Feeding  the  Uncon- 
scious Patient  —  Forced  Feeding  —  Nasal  Feeding  — 
Use  of  the  Stomach  Tube  —  Rectal  Feeding  —  Use  of 
Alcohol  in  the  Sickroom  —  Keeping  Ice  in  the  Sick- 
room —  Disinfecting  •  Utensils. 

V    The  Tray  85 

Attractive  Arrangement  of  a  Tray.  How  to  Serve 
( General  Rules ) . 

VI    Methods  of  Cooking  and  Care  of  Food  88 

Digestibility  and  Nutritive  Value  of  Cooked  Food 

—  Success  in  Cooking  —  Objective  Points  in  Cooking 

—  Effect  of  Heat  —  Principles  Governing  the  Choice 
of  a  Method  of  Cooking  Any  Food  —  Principal  Cook- 
ing Processes  —  The  Object  of  each  Cooking  Process  — 
Cooking  Utensils  —  Blending  Ingredients  —  Method 
of  Working  —  Ice  Box  and  Contents  —  Care  of  Food 

—  Preserving    Foods  —  Concentration  —  Predigestion 
of  Food  —  Adulteration  of  Food. 

VII   Measures  and  Weights  98 

Table  of  Measures  and  Weights  —  Apothecaries 
Weight  —  Apothecaries  Measure  —  Approximate  Meas- 
ures —  Metric  System  —  Measures  of  Volume  —  Meas- 
ure of  Weight  —  Table  of  Equivalents  —  Table  for  Pre- 
paring Percentage  Solution  —  Thermometry. 


PEACTICAL  APPLICATION  OP  PEIiSTCIPLES 


PAET  II 


OP  NUTEITION 


EECIPES 


VIII   Beverages  . 

Acid  Beverages 
Recipes  . 


109 

no 

110 


CONTENTS  Lvii 

CHAPTEH  PAGE 

Albuminous  Beverages   118 

Recipes   118 

Starchy  Beverages   124 

Recipes   124 

Miscellaneous  Beverages   127 

Tea   127 

Recipes   131 

Coffee   128 

Recipes   131 

Chocolate   129 

Recipes   134 

Cocoa   129 

Recipes   133 

Special  Non-Nutritive  Beverages   136 

Recipes   136 

IX   Animal  Foods   138 

Meat   140 

Recipes   .  149 

Poultry  and  Game   152 

Recipes   153 

Fish   159 

Recipes   162 

Fish  Sauces   165 

Recipes   165 

Shell  Fish   166 

Oysters   166 

Recipes  .     .     .     .  '   169 

Clams   168 

Recipes   172 

Eggs   175 

Recipes   179 

Milk  and  Milk  Products   184 

Recipes   193 

Sweetbreads   200 

Recipes  „   201 

Gelatin  ,   203 

Recipes   204 

Beef  Preparations   212 

Beef  Juice  .212 

Recipes   214 


I,YIII 


CONTENTS 


CHAPTER  PAGE 

Beef  Tea   213 

Recipes   215 

Raw  Beef   214 

Recipes   217 

Meat  Broths   217 

Recipes   219 

Meat  Jellies   217 

Recipes   22 

Soups   223 

Recipes  .     .     .  •   223 

Soup  Accompaniments   229 

Recipes   229 

X    Vegetable  or  Plant  Foods   231 

Cereals   233 

Gruels   236 

Recipes   238 

Breakfast  Foods   23^> 

Recipes   242 

Starchy  Jellies   244 

Recipes   244 

Macaroni   24 

Recipes   245 

Bread   247 

Recipes   250 

Toast   2do 

Recipes   256 

Sandwiches   258 

Recipes   259 

Crackers  and  Wafers   260 

Recipes   260 

Vegetables   261 

Recipes   265 

Vegetable  Sauces   27 

Recipes   27 

Salads  272 

Recipes   274 

Salad  Dressings   272 

Recipes   .     .     .  .273 


CONTENTS  Lvix 

CHAPTER  PAGE 

Fruits   276 

Recipes  .     .     .     o   279 

Nuts   283 

Fungi  and  Algae   284 

XI   Nutritious  Desserts  286 

Hot  and  Cold  Desserts  286 

Soft  Custards  287 

Recipes  287 

Baked  Custards  288 

Recipes  288 

Whips  and  Souffles   .     .  290 

Recipes   .     .  291 

Junket   293 

Recipes  293 

Cornstarch  Pudding  or  Blanc  Mange  295 

Recipes  295 

Rice  Puddings  297 

Recipes  297 

Tapioca  300 

Recipes   .300 

Bread  Puddings  ...........  302 

Recipes   302 

Cracker  Puddings   304 

Recipes   .  304 

Pudding  Sauces   305 

Recipes  305 

Frozen  Desserts  306 

Ice  Cream  306 

Recipes  307 

Sherbet  306 

Recipes  312 

Ices  306 

Recipes  313 

XII    Cake     .....    oo    c  317 

Recipes   318 


LX 


CONTENTS 


PAET  III 


HOSPITAL  DIETARIES  —  DIET  IIST  DISEASE 
—  DIET  m  SPECIAL  CONDITIONS 


General.  Types  of  Diet  Used  in  Hospitals  :  — 
Liquid  or  Fluid  Foods  —  Soft  or  Semi-Solid  Food  — 
Solid  Food. 

Typical.  Diets  from  Various  Hospitals  :  —  Light 
Diet    or    Convalescent    Diet  —  Typical    Light  Diet 

—  Milk  Diet— -Fluid  Diet  — Soft  Diet  — Soft  Solids 

—  Liquid  or  Farinaceous  —  Farinaceous  Diet  —  Ni- 
trogenous Diet  • —  Nutrient  Diet  —  Oxaluric  Diet  — 
Strict  Sugar-free  Diet  —  Fat-free  Diet  —  Salt-free 
Diet  — Test  Diet  — Fish  Diet  — Broth  Diet  — Re- 
stricted Diet — -Extra  Diet — -Dietary  of  the  Bellevue 
Hospital,  New  York,  1910  —  Dietary  of  the  Presby- 
terian Hospital,  New  York,  1910. 


DIET  IN  DISEASE 

XIV   Diet  in  Fevers  and  Infectious  Diseases  ....  331 
Diet   in   Fever   in   General  —  Diet   in  Convales- 
cence   from    Fever  —  Typhoid     Fever  —  Starvation 
Treatment  of  Typhoid  —  Liquid  Diet  in  Typhoid  — 
Liberal  or  Generous  Diet  —  Liquid  Diet  in  Typhoid 

—  (1)  Fluid  Diet  in  Typhoid—  (2)  Fluid  Diet  in 
Typhoid  —  Diet  in  Convalescence  from  Typhoid  — 
Diet  in  Typhoid  after  Two  Days  of  Normal  Tempera- 
ture—  Diet  in  Typhoid  after  Two  Weeks  of  Normal 
Temperature  —  Typhoid  Delicacies  —  Typhoid  Extra 
Diet  — Liberal  Diet  in  Typhoid  (Frederick  C.  Shut- 
tuck,    M.D.)  — Tonsilitis    and   Quinsy  —  Diphtheria 

—  Pneumonia  —  Broncho-Pneumonia  —  Mumps  — 
Whooping  Cough  —  Diet  in  Tuberculosis,  Especially 
Pulmonary  Consiunption. 

XV   Diet  in  Disordeks  of  Nutrition  355 

Diet  in  Diabetes  —  Diabetic  Diet  of  Bellevue  Hospi- 
tal—  Diabetic  Diet  of  Presbyterian  Hospital  —  Dia- 


CHAPTER 

XIII    Hospital  Dietaries 


PAGE 

.  323 


CONTENTS 


LXI 


CHAPTER  PAGE 

betic  Diet  of  Massachusetts  General  Hospital  —  Strict 
Sugar-free  Diabetic  Diet  —  Chronic  Diabetes  Diet  — 
Substitutes  for  Starch  and  Sugar  —  A  Diabetic  Chart 
(Elliott  P.  Joslin,  M.D.)  — Menus  for  the  Diabetic 

—  Diet  in  Lithemia  or  Excess  of  Uric  Acid  —  Acute 
Gout  —  Chronic  Gout  —  Acute  Rheumatism  —  Chronic 
Rheumatism  —  Diet  in  Obesity. 

XVI    Diet  in  the  Diseases  of  the  Stomach  373 

Acute  Gastritis  — ■  Chronic  Gastritis  —  Ulcer  of  the 
Stomach  —  Outline  of  Diet  in  Gastric  Ulcer  (Max 
Einhorn,  M.D. )  —  Gastric  Ulcer  Diet  —  Dr.  Hewes's 
Diet,  The  Lenhartz  Diet  —  The  Lenhartz  Diet  Sheet. 

XVir   Diet  in  Intestinal  Diseases  .    .    .    .    .    .     .  .381 

Dyspepsia  —  Constipation  —  Diarrhoea  —  Dysen- 
tery —  Diet  for  Acute  Colitis  ( Dysentery )  —  Chronic 
Dysentery  —  Enteric  Diet  —  Special  Enteric  Diet  — 
Liquid  Enteric  Diet  —  Appendicitis. 

XVIII    Diet  in  Disease  of  the  Genito-Urinary  System  .     ,  390 
Acute  Bright's  Disease  —  Chronic  Bright's  Disease 

—  Nephritic  Diet  —  Acute  Nephritis,  Uric  Acid 
Gravel  —  Convulsion  in  Bright's  Disease  —  Albumi- 


XIX   Diet  in  Miscellaneous  Affections  395 

Nervous  Disorders  —  Functional  Disorders  of  the 
Liver  ( Biliousness )  —  Skin  Diseases  —  Heart  Dis- 
ease —  Dietetic  Management  of  Surgical  Cases  — 
Diet  after  Laparotomy,  Ovariotomy,  etc. 


DIET  IN  SPECIAL  CONDITIONS 

XX   Motherhood  401 

Diet  in  Pregnancy  —  Vomiting  of  Pregnancy  — 
(Vomiting  of  Seasickness)  — Diet  for  the  Mother 
after  Labor  —  Diet  for  a  Nursing  Mother  or  Wet 
Nurse. 


LXII 


CONTENTS 


CHAPTER 

XXI    Infant  Feeding 


PAGE 

.  406 


General  Considerations  —  Breast  Feeding  —  The 
Wet  Nurse  —  Composition  of  Mother's  Milk  —  The 
Hygiene  of  Natural  Feeding  —  Capacity  of  Babies' 
Stomachs  —  Schedule  for  Nursing  —  Weaning  —  Arti- 
ficial or  Bottle  Feeding  —  Difference  Between  Human 
and  Cow^s  Milk  —  General  Principles  of  Milk  Modi- 
fications —  What  Dilution  to  Use  —  The  Quantity  to 
Feed  —  Laboratory  Mjlk  —  Home  Modification  —  The 
Nursing  Bottle  —  Formulae  for  Infant  Feeding  —  Top 
Milk  Method  (L.  Emmett  Holt,  M.D.)  Card  for  Per- 
centage Feeding  of  Infants   (Maynard  Ladd,  M.D.) 

—  Formulae  for  Preparing  Infant  Food  from  Ster- 
ilized Sugar  of  Milk  —  Scheme  for  Feeding  Babies 
(Society  of  the  Lying-in  Hospital,  New  York  City) 

—  Peptogenic  Milk  Powder,  Modifies  Cow's  Milk. 


General  Rules  for  Feeding  Young  Children  —  Table 
of  Comparison,  Food  Reqviired  by  Child  and  Man  — 
Table  showing  Increase  of  Calories  Required  for  a 
Growing  Child  —  Dietaries  for  Young  Children 
(Louis  Starr,  M.D.)  — General  Principles  of  Feeding 
Sick  Children. 


XXIII    Diet  for  the  Adolescent  —  Diet  for  the  Sedentary 


XXII    The  Feeding  of  Young  Children 


434 


—  Diet  for  the  Aged 
Index  to  Recipes  .... 
General  Index   


442 
447 
465 


PART  I 


PRINCIPLES  OF  NUTRITION  AND  FOOD 
PREPARATIONS 


PRACTICAL  DIETETICS 


CHAPTEK  I 
FOOD:    ITS  OBJECT 

Maintenance  of  Life  and  Energy 

There  are  few  subjects  deserving  of  more  careful  consid- 
eration than  that  of  food;  its  composition,  preparation,  and 
effect  upon  the  human  system ;  together  with  the  process  of  its 
conversion  into  complex  animal  tissue,  as  brain  or  muscle, 
blood  or  bone. 

The  true  science  of  feeding  should  be  thoroughly  studied, 
that  we  may  understand  what  properties  enter  into  food; 
what  elements  the  system  demands  in  order  to  build  or  re- 
pair; by  what  means  the  necessary  substances  are  best  sup- 
plied, and  how  to  prepare  them  that  the  body  may  maintain 
its  efficiency;  so  that  in  case  of  illness,  the  least  possible  de- 
mands upon  the  digestive  and  assimilative  functions  may  be 
made. 

Apart  from  the  labor  of  every-day  life  in  which  brain  and 
muscle  engage,  an  immense  amount  of  work  is  performed  in 
the  mere  act  of  keeping  alive.  Nowhere  in  nature  is  work 
performed  without  a  supply  of  energy,  and  also  some  wear 
and  tear  of  the  machine  which  does  the  work.  This  asser- 
tion is  as  true  of  the  human  body  as  of  the  locomotive,  and 
just  as  the  machine  —  whatever  it  may  be  —  requires  to  be 
supplied  with  the  conditions  necessary  for  the  production  of 
force,  so  the  living  body  similarly  demands  a  supply  of  ma- 
terial from  which  its  energy  —  the  power  of  doing  the  work  — 
can  be  taken.    As  the  locomotive  obtains  the  necessary  con- 

3 


4 


PRACTICAL  DIETETICS 


ditions  from  the  fuel  and  water  (and  air)  which  it  consumes, 
so  the  living  body  carries  on  its  activities  by  means  of  the 
food,  water  and  air  upon  which  it  subsists. 

Definition  of  Food.  Foods  are  substances  which  when 
taken  into  the  body  supply  the  necessary  elements  for  pro- 
moting its  growth  and  repairing  its  waste ;  and  furnish  it  with 
material  from  which  to  produce  heat  and  internal  or  external 
work.  Substances  that  are  unable  to  assist  in  either  of  these 
ways  are  called  food  accessories  or  food  adjuncts. 

Food  Accessories  or  Food  Adjuncts.  These  are  substances 
which,  although  unable  to  fulfill  the  definition  of  foods,  find 
an  extensive  use  in  the  dietary,  for  a  variety  of  reasons. 
They  give  flavor  to  food,  increase  the  appetite,  stimulate 
secretion,  and  thus  aid  the  digestive  functions.  They  com- 
prise two  classes,  viz.,  condiments  and  beverages. 

Source  of  Food.  Food  occurs  in  the  mineral,  plant  and 
animal  kingdoms.  It  occurs  in  all  physical  forms  of  matter 
—  gases,  liquids  and  solids.  Gases  are  mentioned  because 
oxygen  is  a  true  food  and  metabolized  to  a  certain  degree, 
being  always  present  in  the  blood  and  tissues  in  loose  chem- 
ical combination. 

Composition  of  the  Body.  The  human  body  contains  many 
chemical  elements  in  varying  amounts. 

Nitrogen,  carbon,  hydrogen,  and  oxygen  are  the  four  pres- 
ent in  largest  proportion;  iron,  phosphorus,  calcium,  mag- 
nesium, potassium,  sodium,  sulphur,  chlorin,  iodin,  also  have 
important  offices  to  perform. 

Composition  of  Food.  Foods  must  contain  the  same  ele- 
ments found  in  the  body;  thus  it  is  that  they  are  able  to 
build  and  maintain  the  body  structure.  But  no  "  one  food 
'Contains  all  these  elements  in  proper  proportions  for  all  per- 
:sons;  therefore,  it  is  by  combinations  of  the  various  food 
:stuflPs  that  we  produce  a  suitable  diet.  These  elements  must 
further  be  supplied  in  forms  which  the  body  can  use.  It 
jMinnot  utilize  carbon  in  the  form  of  coal,  for  example,  but 
must  have  it  combined  in  special  ways  with  hydrogen  and 
oxygen.    These  combinations  of  elements  or  "  Food  Com- 


CLASSIFICATION  OF  FOOD 


5 


pounds     found  in  nature  (sometimes  called  "  alimentary 
or  "food  principles'^  and  "food  stuffs ''),  are  usually  classi- 
fied as  proteins,  fats^  carbohydrates,  mineral  matter  (or  salts) 
and  water. 

Food,  as  it  is  taken  into  the  body  still  differs  in  composi- 
tion from  the  material  utilized  by  the  tissues  in  growth, 
repair  of  waste,  and  production  of  energy  in  the  form  of  work 
or  heat.  It  must  be  finally  prepared  for  the  use  of  the  body 
by  the  processes  involved  in  Digestion. 

CLASSIFICATION  OF  FOOD 

Foods  may  be  classified  in  various  ways : 

a.  According  to  Source,  as  animal,  vegetable,  and  mineral 
(including  oxygen  for  combustion). 

b.  According  to  Chemical  Composition,  as  organic  and  in- 
organic, the  organic  foods  being  further  subdivided  into  ni- 
trogenous and  non-nitrogenous  substances. 

c.  According  to  Function,  as  tissue-formers,  or  body-build- 
ers; energy  (or  work  and  heat)  producers;  and  regulators  of 
body  processes. 

Classification  according  to  Chemical  Composition 
"  ISTitrogenous  —  Proteins 

rSugars 


Organic" 


Inorganic^ 


{Carbohydrates  _ 
I  Starches 
Fats 

(Mineral  Matter 
Water 

Classification  according  to  Function 
r  Proteins 

Tissue-formers  or  Body-builders       -]  Mineral  Matter 

IWater 

(Carbohydrates 
Fats 
Proteins 


6 


PRACTICAL  DIETETICS 


Eegulators  of  Body  Processes 


Mineral  Matter 
Water 


Important  Sources  of  Proteins: 

Milk,  eggs,  meat,  fish,  cheese,  beans,  peas,  lentils,  some  nuts 
and  cereals. 
Important  Sources  of  Fats: 

Olive  oil,  butter,  cream,  bacon  and  other  fat  meat,  and  nuts. 
Important  Sources  of  Carbohydrates: 

Cereals,  and  cereal  products;  sago,  tapioca;  starchy  veg- 
etables, such  as  potatoes ;  sugar,  honey,  sweet  dried  fruits. 
Important  Sources  of  Mineral  Matter: 

a.  Available  in  organic  form: 

Nitrogen, —  supplied  by  protein. 

Phosphorus, —  in  milk  and  cream,  eggs  (especially 

the  yolk),  meat,  whole  wheat,  oatmeal,  dried  peas 

and  beans. 

Iron, —  in  eggs  (especially  the  yolk),  meat,  whole 
wheat,  oatmeal,  dried  and  fresh  peas  and  beans, 
spinach,  raisins  and  prunes. 

b.  Available  in  organic  or  inorganic  form : 

Calcium,  in  milk,  dried  beans  and  peas,  oranges, 
spinach,  turnips ;  other  fresh  fruits  and  vegetables, 
and  whole  grains. 

Magnesium,  potassium,  iodin,  etc. —  likely  to  be 
adequately  supplied  if  the  other  ash  constituents 
are  provided  for.  The  addition  of  sodium  chloride 
(common  salt)  as  a  condiment  usually  supplies  a 
surplus  of  sodium  and  chlorin. 

Special  Functions  of  each  Food  Principle: 

Proteins  —  Supply  energy,  nitrogen,  sulphur,  and  some- 
times phosphorus  and  iron. 

Pats  —  Supply  energy  in  the  most  concentrated  form. 

Carbohydrates  — -  Supply  energy  in  the  form  most  econom- 
ical to  the  body. 

Mineral  Matter  —  Supplies  building  material,  except  nitro- 
gen and  sulphur,  and  helps  to  regulate  body  processes. 


CONDITIONS  FOR  PERFECT  NUTRITION  7 


Water — Supplies  building  material  (forming  60  per  cent, 
of  the  body),  and  helps  to  regulate  body  processes. 

CONDITIONS  FOR  PERFECT  NUTRITION 

For  the  proper  support  of  the  human  system,  a  combina- 
tion of  nitrogenous  and  non-nitrogenous  foods  is  essential, 
with  water  to  dissolve  them  and  oxygen  to  burn  them.  Al- 
though air  is  not  classified  as  a  food  it  is  essential  to  effect 
the  chemical  changes  needful  for  assimilation.  About  two 
thousand  cubic  feet  of  air  need  to  pass  through  the  lungs  of 
an  adult  daily  in  order  to  furnish  oxygen  in  sufficient  quan- 
tity. If  there  is  lack  in  this  most  important  food-stuff  (and 
nothing  else  can  take  its  place),  starvation  as  truly  results 
as  if  other  food  were  withheld,  for  the  changes  required  for 
nutrition  cannot  take  place,  and  furthermore  incomplete  de- 
composition occurs,  which  may  result  in  more  or  less  poison- 
ous products. 

"  Fresh  air  —  air  with  its  quota  of  oxygen  —  is,  then,  a 
prime  requirement  in  nutrition.^^ —  Ellen  H.  Eichards. 

A  Perfect  Food.  1.  ^'  A  perfect  food  must  contain  all  the 
nutritive  elements  of  the  body :  Proteins^  carbohydrates,  fats, 
minerals,  and  water. 

2.  It  must  contain  these  in  their  proper  proportions. 

3.  It  must  contain  in  a  moderate  compass  the  total  amount 
required  daily. 

4.  The  nutritive  elements  must  be  capable  of  easy  absorp- 
tion, and  yet  leave  a  certain  bulk  of  unabsorbed  matter  to 
act  as  intestinal  ballast.  It  must  be  obtainable  at  a  mod- 
erate cost.^^ —  Hutchinson. 

A  Mixed  Diet  therefore  is  necessary,  as  no  "one  food^^ 
fulfills  all  the  requirements  of  a  "perfect  food.'^  A  mixed 
diet  must  be  taken  whereby  one  food  may  be  used  to  sup- 
plement what  is  lacking  in  another.  The  foods  best  for 
health  are  those  best  fitted  to  the  needs  of  the  individual. 
The  cheapest  food  is  that  which  furnishes  the  largest  amount 
of  nutriment  at  the  least  cost.  The  best  food  is  that  which 
is  both  healthful  and  cheapest. 


8 


PRACTICAL  DIETETICS 


NITROGENOUS  FOODS 


Mtrogenous  substances  are  those  which  contain  nitrogen, 
an  element  which  is  essential  to  the  life  of  every  cell. 

Classification.  In  older  classifications,  the  term  Protein 
is  used  to  include  all  food  substances  containing  nitrogen, 
this  class  being  further  subdivided  into  (1)  Proteids,  those 
proteins  which  can  alone  maintain  the  nitrogen  equilibrium 
of  the  body;  (2)  Albuminoids  or  Gelatinoids,  those  which 
contain  nitrogen  in  a  form  which  can  replace  other  proteins 
only  to  a  limited  extent;  (3)  Extractives,  containing  nitro- 
gen in  a  form  unable  to  make  good  the  body  loss  of  nitrogen. 
These  extractives  are  properly  food  accessories. 

Proteins  are  now  defined  as  compounds  of  carbon,  hydrogen, 
oxygen,  nitrogen,  sulphur^  and  sometimes  phosphorus,  which 
contain  nitrogen  in  a  form  which  the  body  can  use.  They  are 
variously  classified,  but  a  simple  division  is  one  into  (1) 
Simple  Proteins,  (2)  Compound  Proteins,  and  (3)  Albumi- 
noids. Examples  of  simple  proteins  are  albumins,  globulins, 
and  certain  alcohol-soluble  proteins  found  in  cereals,  as  the 
gliadin  of  wheat ;  of  compound  proteins,  the  nucleo-protein  of 
organs  consisting  chiefly  of  nucleated  cells,  as  pancreas  or 
sweetbread,  and  the  haemoglobin  of  the  blood ;  of  albuminoids, 
the  familiar  product,  gelatin,  formed  from  the  collagen  of 
connective  tissue: 


Proteins  ^ 


Simple 


Albumins,  e.  g. 


Globulins,  e.  g. 


^White  of  egg. 
Casein  of  milk. 
Myosin  of  muscle. 
'  Fibrin  of  blood. 
Gluten  of  wheat. 
^Legumin  of  legumes. 

In  grains. 
fGliadin  of  wheat. 


^Alcohol-soluble  proteins  e.  g.  .  . 


Zein  of  maize. 


Albuminoid    Collagen  of  connective  tissue. 


NITROGENOUS  FOODS 


9 


Source,  The  proteins  of  the  diet  are  derived  both  from  the 
animal  and  vegetable  kingdoms.  The  principal  animal  pro- 
teins are  obtained  from  meats,  fish;,  eggs,  and  milk.  Meat 
and  fish  proteins  are  derived  principally  from  the  muscles; 
egg  proteins  from  both  the  white  and  yolk;  milk  proteins 
chiefly  from  the  casein,  which  forms  the  main  constituent  of 
cheese  and  curds.  Animal  foods  are  much  richer  in  protein 
than  plant  foods.  The  only  substances  of  vegetable  origin 
which  can  compare  with  animal  nutrients  in  this  respect  are 
the  legumes  (peas,  beans,  lentils,  peanuts,  etc.),  and  certain 
nuts,  such  as  almonds,  pine  nuts,  cocoa  beans  (the  source  of 
cocoa  and  chocolate).  The  entire  grain  of  some  cereals  pos- 
sesses a  high  percentage  of  protein;  this  is  particularly  true 
of  so-called  hard  wheat,  and  in  lesser  degree  of  oats,  Indian 
corn,  rye,  and  barley.  As  a  rule,  flour  and  meal  are  about 
half  as  rich  in  protein  as  the  dried  grains  from  which  they 
are  prepared,  though  oatmeal  and  Indian  meal  lose  but  lit- 
tle through  milling. 

Animal  foods  are  usually  digested  with  ease,  and  require 
less  cooking  and  less  mastication  to  insure  good  utilization; 
in  the  form  of  meat,  they  are  liked  because  of  their  high 
flavor  and  stimulating  properties.  In  vegetable  foods,  on 
account  of  the  presence  of  cellulose,  some  of  the  protein  is 
likely  to  escape  digestion  and  absorption.  Eor  the  invalid 
or  convalescent,  certain  animal  foods  are  preferred  as  a 
source  of  protein,  as  being  more  concentrated,  and  easier  of 
digestion.  Of  ordinary  vegetable  food  rich  in  protein,  bread, 
either  stale  and  dry,  or  thoroughly  toasted,  is  perhaps  the 
most  suitable  for  invalids.  Starchy  roots  and  tubers  (as' 
potatoes),  and  green  vegetables  and  fruits,  though  valuable 
for  other  dietetic  reasons,  are  very  poor  in  protein. 

Animal  Proteins.  The  albumins  in  the  ordinary  diet  are 
derived  chiefly  from  animal  foods.  The  white  of  egg  is  a 
very  pure  form  of  this  compound,  and  eggs  constitute  one 
of  the  best  sources  of  nitrogen  in  a  compact  and  assimilable 
form,  especially  convenient  as  they  are  readily  taken  raw. 

Casein,  the  chief  protein  of  milk,  represents  the  main 


10 


PRACTICAL  DIETETICS 


source  of  this  food  element  for  infants  and  the  sick.  One 
quart  of  milk  contains  as  much  protein  as  six  ounces  of  lean 
beeksteak,  and  is  more  valuable  because  of  its  rich  supply 
of  mineral  matter,  to  say  nothing  of  the  fat  and  carbohydrate 
present. 

Myosin  is  the  typical  protein  in  muscle  tissue.  After  death 
it  changes  to  a  form  called  syntonin. 

Fibrin  and  Serum  Albumin,  found  in  blood,  occur  to  a 
slight  extent  along  with  myosin  in  meat. 

The  only  albuminoid  which  requires  consideration  here  is 
collagen,  a  protein  found  in  all  connective  tissues,  including 
the  modified  forms,  such  as  cartilage  and  bone.  This  sub- 
stance is  changed  by  boiling  to  gelatin.  This  is  further  al- 
tered by  the  gastric  juice  to  gelatoses  and  gelatin-peptones, 
and  finally  absorbed,  but  it  lacks  certain  elements  found  in 
albumins  and  other  proteins,  and  consequently  cannot  be  re- 
lied upon  exclusively  as  a  source  of  nitrogen  for  the  body. 
It  can  replace  about  two-thirds  of  the  ordinary  protein  re- 
quirement. 

yegetable  Proteins.  These  are  chiefly  globulins.  The 
main  representatives  of  the  albumins  in  vegetable  food  are 
gluten  of  wheat  and  legumin  of  the  legumes.  A  number  of 
alcohol-soluble  proteins  occur,  such  as  gliadin  in  wheat  and 
zein  in  Indian  corn.  Vegetables  contain  a  large  number  of 
nitrogenous  substances  which  are  not  proteins.  Thus  while 
mushrooms  contain  much  nitrogen,  little  of  it  is  in  a  form 
which  can  be  utilized  by  the  body.  • 

Function  of  Proteins,  Proteins  are  both  body-builders  and 
energy-producers,  but  are  little  utilized  as  fuel  when  carbo- 
hydrates and  fats  are  well  represented  in  the  diet.  As  a  fuel, 
they  tend  to  burn  up  rapidly,  and  hence  are  not  economical, 
and  since  in  health  only  a  small  proportion  of  nitrogen  is 
used  from  day  to  day,  the  part  not  needed  being  promptly 
excreted,  it  is  not  advantageous  to  have  the  diet  largely  com- 
posed of  this  foodstuff.  During  the  periods  of  rapid 
growth,  in  the  prenatal,  infantile  and  adolescent  states,  when 
the  body  is  forming  new  tissue  at  an  unusual  rate,  there  must 


NITROGENOUS  FOODS 


11 


be  a  liberal  nitrogen  supply.  This  is  also  true  in  conva- 
lescence from  wasting  disease,  and  sometimes  after  excessive 
physical  exertion,  when  the  muscle  tissue  is  actually  increas- 
ing. In  healthy  when  fats  and  carbohydrates  are  liberally 
provided,  so  that  the  protein  is  not  required  as  fuel,  a  com- 
paratively small  amount  is  needed  for  repair  of  tissue.  This 
is  especially  true  in  old  age.* 

Nitrogenous  Extractives.  Substances  found  in  muscle 
juice,  consisting  chiefly  of  creatin,  creatinin,  and  purins 
(uric  acid  and  related  substances),  are  valuable  only  as  stim- 
ulants. They  give  sapidity  to  meats  and  hence  are  appetiz- 
ing; possess  the  power  of  stimulating  the  flow  of  gastric  juice, 
and  by  their  influence  on  the  nervous  system,  gently  in- 
crease the  activity  of  the  heart.  For  this  reason,  beef  tea, 
beef  extracts,  etc.,  are  of  value  to  the  sick. 

Cooking  of  Protein.  Of  all  the  proteins,  Albumin,'^  of 
which  there  are  many  varieties,  is  the  most  important  and 
needs  most  care  in  the  cooking  to  make  it  easily  digested. 

The  majority  of  albumins  are  soluble  in  cold  water  and 
Tegetable  acids;  they  are  coagulated  by  heat,  mineral  acids 
and  alcohol.  The  cooking  of  albumin  should  be  governed  by 
these  facts. 

"As  the  white  of  the  egg  is  nearly  pure  albumin  it  will 
serve  as  an  excellent  substance  for  demonstrating  the  effect 
of  heat  on  the  principal  constituent  of  albuminous  foods.^^ 

Effect  of  Temperature  or  Test  for  CooTcing  Albumin 
Into  a  test  tube  put  some  white  of  egg,  place  in  a  sauce  pan 
of  cold  water,  heat  gradually,  and  observe  all  changes. 

1.  Eaw  white  of  egg  is  a  sticky,  clear,  pale  straw-colored 
liquid,  and  readily  digested. 

2.  When  water  reaches  the  temperature  134°  F.  white 
streaks  will  be  seen  in  a  semi-solid  white  substance  which  is 
found  to  be  readily  digested. 

3.  When  water  reaches  the  temperature  160°  F.  the  egg 
will  be  firm,  soft,  and  jelly-like,  and  is  readily  digested. 

4.  When  water  reaches  212°  F.  the  egg  will  be  tough  white 
jelly  and  less  readily  digested. 

*  See  note  page  106. 


12 


PRACTICAL  DIETETICS 


5.  When  egg  is  heated  to  300°  F.  or  higher  (for  example 
put  the  test  tube  directly  over  flame),  the  egg  will  almost 
immediately  become  hard  and  tenacious. 

These  albumin  tests  demonstrate  that  albuminous  foods 
are  most  tender  and  readily  digested  when  cooked  at  a  low 
temperature  but  when  coagulated  at  too  high  a  temperature 
are  tough  and  indigestible. 

Eeheated  albuminous  foods  are  less  digestible  than  freshly 
cooked  because  the  albumin  is  much  hardened  by  the  second 
cooking.  The  principal  foods  requiring  care  in  preparation 
because  of  the  albumin  are  eggs,  meat,  and  fish.  These  will 
be  considered  further  under  their  separate  headings. 

NOH-NITROOENOUS  POODS 

CARBOHYDRATES  (SUGAR  AND  STARCH):  FATS 

Strictly  speaking,  any  food  substance  not  protein,  even 
water  and  mineral  w^ater,  is  non-nitrogenous;  but  in  the  re- 
stricted sense  of  food  as  a  source  of  energy,  it  is  applied  to 
two  classes  of  organic  compounds  which  contain  no  nitrogen^ 
viz.,  carbohydrates  and  fats. 

CARBOHYDRATES 

Definition.  Carbohydrates  are  food  substances  which  con- 
tain carbon,  hydrogen  and  oxygen.  The  oxygen  and  hydro- 
gen are  usually  present  in  proportion  to  form  the  water  mole- 
cule (H2O).  These  substances  have  therefore  been  termed 
carbohydrates.  A  carbohydrate  may  be  defined  as  a  simple 
sugar,  or  a  substance  which  yields  simple  sugar  after  hy- 
drolysis. 

Source.  Carbohydrates  come  from  the  vegetable  kingdom 
almost  entirely.  There  are  a  few  exceptions,  such  as  glycogen 
and  milk  sugar.  They  abound  throughout  the  plant  world, 
but  especially  in  grains,  roots,  tubers,  or  wherever  the  plant 
stores  its  reserves. 

Function.  Carbohydrates  are  burned  up  in  the  body  to 
produce  energy  in  the  form  of  work  or  heat.  All  that  is 
taken  in  excess  of  immediate  need  is  stored,  first  as  glycogen 


NON'NITROGENOUS  FOODS 


13 


or  animal  starch  in  the  liver  and  muscles ;  and  when  the 
capacity  to  store  glycogen  is  exhausted,  in  the  form  of  fat. 
The  fuel  value  of  fat  is  two  and  one-fourth  times  that  of 
sugars  and  starches,  so  that  this  is  a  very  convenient  form 
of  storage  of  surplus  carbohydrate. 

The  Most  Important  Energy  Producing  Foods  are  cereals, 
potatoes,  tapioca,  sago,  fats,  sugar  and  honey. 

Classification,  Carbohydrates  include  the  monosaccharides, 
as  typified  in  grape  sugar;  the  disaccharides,  as  typified  in 
cane  sugar,  and  polysaccharides,  including  starch,  dextrin, 
gums,  cellulose  and  glycogen: 


Carbohydrates 


r  Grape  Sugar   (Dextrose  or  Glucose) 
MnTio«!nprhnriflP«s    I  ^'^^^^  Sugar  (Levulose) 
Monosaccharides  ^  mixture  of  dextrose  and  levulose  is 


C6H12O6 


Disaccharides 

Ci2H220ii 


Polysaccharides 
CeHioOs 


called  Invert  Sugar.  Honey 
L         best  example  in  nature) 

I Cane  Sugar  "| 
Beet  Sugar      Y  Sucrose 
Maple  Sugar  J 
Milk  Sugar  (Lactose) 
Malt  Sugar  (Maltose) 

r  Starch  . 
J  Dextrin 
"5  Glycogen 
I  Gums 
L  Cellulose 


is  the 


Sugar 

Definition.  Sugars  are  carbohydrates  which  are  soluble, 
have  a  more  or  less  sweet  taste  and  many  minor  qualities 
which  distinguish  them  from  the  starches.  The  disaccharides 
yield  monosaccharides  under  the  influence  of  enzymes  or  on 
boiling  with  dilute  acids.  When  heated  to  a  high  tempera- 
ture sugars  form  caramel.  In  dietetics  we  are  especially 
concerned  with  grape  sugar  (dextrose),  milk  sugar  (lactose) 
and  cane  sugar  (sucrose). 

DEXTROSE  OR  GRAPE  SUGAR  (GLUCOSE) 

Description,  Dextrose  occurs  as  a  syrup^  rarely  in  crystal- 
line form.  It  is  much  less  sweet  than  cane  sugar.  Other 
sugars  have  to  be  changed  to  this  form  before  the  body  can 
use  them. 


14 


PRACTICAL  DIETETICS 


Sources,  It  is  found  throughout  the  vegetable  kingdom^, 
and  especially  in  fruits.  A  dried  fig  contains  65  per  cent, 
of  grape  sugar.  In  nature  it  is  formed  from  starch  and  so 
it  may  be  produced  in  art  by  treating  starch  with  acids.  It 
is  prepared  on  a  large  scale  from  cornstarch. 

Uses  as  Food.  Dextrose  or  grape  sugar  is  a  fuel  food  in 
one  of  its  most  readily  absorbed  forms.  It  does  not  require 
digestion  because  this  is  the  form  to  which  carbohydrates  of 
all  kinds  must  be  changed  before  they  can  be  of  use  to  the 
body.  Taken  in  large  quantities  it  is  liable  to  ferment,  or 
flood  the  system  with  sugar  too  rapidly,  but  as  naturally 
present  in  sweet  fruits,  or  in  its  artificial  form  in  small 
quantities  along  with  other  food-stuffs,  it  is  a  very  economical 
source  of  energy. 

LACTOSE 

Milk  Sugai'  or  Lactose.  This  sugar  is  found  almost  ex- 
clusively in  milk,  from  which  it  is  commercially  prepared.  It 
has  little  sweetness  and  does  not  readily  ferment.  Until  re- 
cently it  has  entered  but  little  into  practical  dietetics,  save 
in  case  of  infants  or  others  subsisting  wholly  or  partly  on 
milk,  but  its  ease  of  assimilation  and  its  mild  flavor,  make 
it  frequently  a  valuable  source  of  energy  in  disease,  and  it- 
is  more  and  more  widely  used. 

CANE  SUGAR 

Pure  cane  sugar  is  chemicall}^  the  same  as  beet-sugar. 
Maple  sugar  would  not  be  different  from  common  sugar,  if 
it  were  sufficiently  purified  to  remove  the  flavoring  matter. 

Description.  Cane  sugar  occurs  naturally  in  crystals,  some 
of  which  are  extremely  hard  (rock  candy)  ;  and  in  syrups,  one 
of  which  is  molasses. 

Sources,  etc.  Cane  sugar  is  found  in  the  sap  or  juices  of 
a  variety  of  plants,  including  sugar  cane,  the  beet,  the  sugar 
maple,  etc.  Whether  obtained  by  collecting  sap  or  crushing, 
etc.,  it  is  always  at  first  a  syrup  and  all  solid  sugar  is  obtained 
from  these  juices  by  various  methods. 

Uses  as  Food.  Cane  sugar  enters  into  the  dietary  very 
largely,  pure  for  table  use  and  in  confectionery,  or  in  com- 


NON-NITROGENOUS  FOODS  15 


binations  with  other  foods  in  cookery.  It  is  a  very  valuable 
source  of  energy,  but  must  be  used  with  discretion,  because 
in  too  large  amounts  or  in  too  concentrated  form  it  is  irri- 
tating to  the  stomach  and  liable  to  ferment,  and  also  be- 
cause being  quickly  absorbed,  it  satisfies  the  appetite  before 
the  need  for  food  has  been  entirely  met,  or  blunts  it  so  that 
other  foods  become  distasteful.  A  pound  of  sugar  and  a 
pound  of  pure  cornstarch  are  nearly  equal  in  energy  value.* 
Tor  children,  it  is  much  better  to  give  sugar  in  the  form  of 
sweet  fruits,  because  they  are  then  supplied  with  valuable 
mineral  salts  which  are  entirely  lacking  in  pure  sugar. 

Substitute  for  Sugars.  Since  sugar  is  used  not  only  as  a 
fuel  food  but  as  a  condiment,  attempts  have  been  made  to 
secure  a  substitute  for  use  in  cases  where  carbohydrate  is 
limited  or  denied.  The  best  known  of  these  is  "  saccharin 
or  sweetina,'^  a  crystalline  coal-tar  product.  It  is  many 
times  sweeter  than  sugar,  but  it  has  no  food  value. 

Use  of  Sugar  in  Practical  Dietetics.  Sugar  taken  in  small 
quantities  will  replace  starch  weight  for  weight,  and  be  more 
easily  and  quickly  absorbed.  The  amount  of  sugar  which 
can  be  taken  in  place  of  other  fuel  food  depends  on  the 
amount  of  exercise  and  the  peculiarities  of  the  individual. 
An  excess  of  sweets  may  cause  nausea  and  always  blunts  the 
appetite,  thus  cutting  down  the  consumption  of  other  foods. 
If  a  very  large  amount  be  taken,  sugar  will  appear  in  the 
urine.  The  maximum  advisable  daily  allowance  of  sugar  is 
considered  to  be  about  four  ounces. 

Sugar  should  be  avoided  in  gastric  disorders,  such  dis- 
turbances of  nutrition  as  gout,  rheumatism,  and  especially 
diabetes.  Being  a  highly  concentrated  food,  it  should  be 
avoided  in  obesity. 

Uses  of  Sugar  in  Cookery.  Glucose  is  not  so  sweet  as  cane 
sugar,  so  that  when  used  for  sweetening  other  foods  a  larger 
amount  must  be  taken.  In  cooking  fruits,  sugar  should  be 
added  when  the  process  is  nearly  complete,  as  it  tends  to 
harden  the  fruit  tissues.  By  boiling  for  a  long  time  or  in 
the  presence  of  acids  (whether  naturally  in  the  fruit  or  added 

^  *  A  pound  of  sugar  might  all  be  eaten  quickly,  but  it  would  be  almost 
impossible  to  eat  a  pound  of  cooked  constarch  at  once. 


16 


PRACTICAL  DIETETICS 


to  it)  cane  sugar  is  changed  to  invert  sugar^  which  is  a 
mixture  of  equal  parts  of  dextrose  and  levulose.  While  dex- 
trose is  not  so  sweet  as  cane  sugar,  levulose  is  very  much 
sweeter,  so  that  the  resulting  product  has  a  peculiar,  pene- 
trating sweetness  that  is  not  so  well  liked  as  the  cane  sugar 
flavor.  This  is  another  reason  for  reserving  the  sugar  till 
the  end  of  the  cooking  process. 

Test  for  Sugar.  A  simple  test  for  sugar,  irrespective  of 
whether  it  is  glucose  or  cane  sugar,  consists  in  adding  a  little 
33  per  cent,  solution  of  caustic  soda  to  the  suspected  solution, 
and  boiling.    If  sugar  is  present  the  solution  turns  brown. 

The  chief  test  for  glucose  or  grape  sugar  alone  is  Fehling's. 
A  test  solution  should  be  on  hand,  and  may  be  obtained  at  any 
apothecary's.  It  should  be  obtained  fresh.  The  test  is  based 
on  the  fact  that  glucose  "  reduces  salts  of  copper,  i.  e.,  by 
depriving  them  of  some  of  their  oxygen,  an  insoluble  oxide 
of  copper  is  precipitated.  The  test  solution  contains  sulphate 
of  copper,  caustic  potash  and  tartrate  of  sodium  and  potas- 
sium. To  make  the  test,  add  to  a  portion  of  the  test  solution 
a  few  drops  of  the  suspected  solution  in  a  test  tube  and  boil. 
If  a  red  substance  precipitates,  glucose  is  present.  The  sole 
use  of  this  test  for  the  nurse  will  probably  be  in  connection 
with  diabetes,  when  the  nurse  makes  the  test  at  the  request  of 
the  medical  attendant.  In  all  other  tests  for  sugar,  the  first 
test  mentioned  above  will  suffice,  and  would  also  suffice  for  dia- 
betic urine  were  it  not  for  the  fact  that  a  shamming  patient 
could  deceive  the  nurse  by  placing  common  sugar  in  her  urine. 

Starch  and  Other  Polysaccharides 

Starchy  foods  form  a  large  part  of  the  ordinary  diet  of 
man ;  they  are  the  chief  source  of  the  carbohydrates.  Starch, 
unlike  sugar,  is  insoluble  but  may  be  made  to  pass  into  a 
soluble  form  by  dry-heating  at  high  temperature,  or  by  cer- 
tain digestive  ferments.  The  first  bodies  formed  are  known 
as  dextrins,  but  ultimately  a  sugar  (maltose)  is  produced. 
The  alimentary  starches  may  be  said  to  comprise  starch 


NON-NITROGENOUS  FOODS  17 


proper;  dextrins  or  soluble  starches;  and  glycogen  or  animal 
starch,  which  is  stored  np  in  the  liver. 

Source.  Starch  occurs  widely  in  the  vegetable  kingdom, 
along  with  grape  sugar.  It  is  found  in  largest  amounts  in 
grains,  seeds,  roots  and  tubers.  It  is  prepared  for  the  market 
chiefly  by  mechanical  means,  being  washed  out  of  the  finely 
cut  vegetable  substances.  Its  main  commercial  source  is 
probably  wheat,  but  it  is  also  made  largely  from  potatoes,  rice, 
arrow-root,  etc. 

Description,  In  its  pure  state,  i.  e.,  when  isolated  from 
proteins,  cellulose,  gum,  etc.,  starch  is  a  shining  white  pow- 
der having  a  distinctive  quality  to  the  touch.  Under  the 
microscope  it  is  found  to  consist  of  granules^  which  are  in- 
soluble in  cold  water.  When  heated  to  a  high  temperature, 
these  granules  undergo  a  certain  amount  of  transforma- 
tion into  soluble  starch  and  dextrin.  Boiling  the  starch 
in  water  has  the  same  results.  The  action  of  the  group 
of  ferments  known  as  diastases  is  to  transform  starch  suc- 
cessively into  soluble  starch,  dextrin,  and  finally  maltose 
(malt  sugar). 

Uses  as  Food.  Starch  is  seldom  used  pure  in  dietaries,  but 
with  other  food  principles  in  the  form  of  various  flours  and 
bread  made  from  them,  or  as  breakfast  cereals,  legumes,  po- 
tatoes, etc.  The  breads  baked  from  wheat  flour  are  among 
the  most  widely  distributed  foods. 

Other  Polysaccharides.  Aside  from  starch  and  sugar  the 
polysaccharides  contribute  but  little  to  dietetic  uses.  Cellu- 
lose, the  framework  of  plants,  constitutes  the  largest  propor- 
tion of  their  bulk.    It  is  the  principal  part  of  the  so-called 

indigestible  residue  of  digestion ;  and  hence  the  amount 
of  the  residue  varies  greatly  with  the  nature  of  the  food 
eaten.  Without  nutritive  value,  it  is  still  believed  to  be  of 
service  as  a  stimulant  to  intestinal  peristalsis,  by  acting  as 
a  gentle  mechanical  irritant;  by  helping  to  retain  moisture 
and  keep  the  feces  soft;  and  by  giving  such  bulk  that  the 
intestinal  muscles  can  act  to  good  advantage.  When  attacked 
by  bacteria,  it  forms  acids  which  are  valuable  checks  to  in- 


18 


PRACTICAL  DIETETICS 


testinal  putrefaction.  Unless  it  is  desirable  for  some  special 
reason  to  relieve  the  digestive  tract  of  all  work^  a  certain 
amount  of  cellulose  should  be  included  in  the  diet.  In  con- 
stipation the  addition  of  some  non-irritating  form^  as  agar- 
agar  has  proved  a  successful  therapeutic  measure. 

Gums,  taken  incidentally  into  the  body,  represent  little  or 
no  nutritive  value,  and  like  cellulose  act  as  "  ballast.'^ 

Principles  of  Cooking  Starch,  The  principles  involved  in 
the  cooking  of  starch  are  of  two  types  —  chemical  and  me- 
chanical. 

Chemical  Principles.  Since  raw  starch  is  digestible  only 
to  a  slight  degree,  it  is  essential  to  perfect  digestion  that 
starchy  foods  be  cooked. 

In  the  presence  of  moisture,  starch  is  made  soluble  at  the 
temperature  of  boiling  water,  i.  e.,  212°  P.  By  long  boiling, 
this  soluble  starch  can  be  converted  into  dextrin,  a  still  more 
easily  digested  form  than  soluble  starch.  This  principle  is 
applied  in  the  making  of  gruels,  especially  for  invalids  and 
infants. 

By  dry  heat,  at  a  temperature  considerably  above  212°  P. 
(300°  P.-400°  P.)  starch  can  be  converted  quite  readily  to 
dextrin.  This  principle  is  applied  in  making  toast.  Some 
of  the  starch  is  further  changed  to  caramel,  giving  a  char- 
acteristic flavor  to  the  crust  of  bread,  toast,  etc. 

Mechanical  Principles.  When  foods  composed  almost  en- 
tirely of  pure  starch,  such  as  flour,  cornstarch,  etc.,  are  to 
be  cooked  with  a  liquid,  care  must  be  taken  to  prevent  the 
formation  of  lumps,  for  these  are  not  only  unsightly,  but  con- 
sist of  an  outer  layer  of  soluble  starch  surrounding  a  center 
of  unchanged  material  and  preventing  its  being  made  di- 
gestible. 

There  are  three  methods  of  avoiding  lumps :  — 

1.  By  mixing  the  starch  gradually  with  a  small  portion 
of  cold  water,  so  that  a  smooth  fluid  mass  is 
formed,  before  adding  the  boiling  liquid.  This 
method  is  useful  in  making  gruels,  etc. 


NON-NITROGENOUS  FOODS 


19 


2.  By  mixing  with  fat  before  adding  liquid.    The  melt- 

ing fat  separates  the  starch  granules.  At  least  as 
much  fat  as  starch  must  be  used.  The  liquid  is 
preferably  added  cold^  and  all  at  once.  If  added 
hot,  it  must  be  stirred  in  very  gradually.  This 
method  is  employed  in  making  gravies,  sauces,  etc. 

3.  By  mixing  with  sugar.    The  melting  sugar  serves 

to  separate  the  starch  grains.  This  is  practicable 
only  when  the  sugar  is  greater  in  amount  than  the 
starch,  and  the  liquid  must  be  added  gradually. 
This  method  is  applied  in  the  case  of  desserts,  such 
as  cornstarch  pudding. 

When  foods  consisting  of  a  mixture  of  starch  and  cellulose, 
as  cereal  breakfast  foods,  are  to  be  cooked,  it  is  necessary  to 
soften  and  break  up  the  cellulose  to  enable  the  digestive  juices 
to  reach  the  starch.  This  necessitates  long  cooking  at  a 
temperature  near  the  boiling  point.  The  longer  such  a  cereal 
product  is  cooked,  the  easier  of  digestion  it  becomes.  Hence 
it  is  an  excellent  rule  to  cook  such  foods  for  infants  and  others 
of  feeble  digestive  powers,  twice  as  long  as  is  commonly  recom- 
mended. 

Eeheating  of  starchy  foods,  therefore,  tends  to  increase 
their  digestibility.  Zwieback  (or  twice-baked  bread)  is  more 
digestible,  for  example,  than  fresh  bread. 

Test  for  Starch,  Starch  is  colored  blue  by  iodin.  Hence 
it  is  easy  to  detect  its  presence  in  any  food.  To  make  the 
test,  a  small  portion  of  the  material  should  be  placed  in  a 
test  tube,  boiled  with  a  little  water,  cooled,  and  two  or  three 
drops  of  dilute  tincture  of  iodiii  added.  If  starch  is  present, 
the  blue  color  will  immediately  appear.  Dextrin  gives  a  port- 
wine  color  with  iodin,  so  that  if  any  of  this  substance  be 
present,  the  color  is  modified,  becoming  more  or  less  purplish, 
or  purple-red. 

FATS  AND  OILS 

Definition,  Fats  are  food-stuffs  having  the  same  ultimate 
chemical  composition  as  carbohydrates;  i.  e.,  consisting  of 


20 


PRACTICAL  DIETETICS 


carbon^  hydrogen  and  oxygen,  but  the  latter  element  is  pres- 
ent in  less  proportion  than  in  carbohydrates.  Fats  were 
formerly  spoken  of  as  hydrocarbons,  but  this  term  is  now 
reserved  for  substances  which  contain  no  oxygen  at  all,  such 
as  benzine. 

Description.  True  fats,  whether  solid  or  oily,  are  chem- 
ically compounds  of  fatty  acids  with  glycerine,  and  differ 
among  themselves  according  to  the  particular  fatty  acids  they 
contain.  These  commonly  comprise  stearic,  palmitic  and 
oleic  acids.  The  stearates  or  combinations  of  stearic  acid 
with  glycerine  (also  generally  spoken  of  as  stearins)  are  solid 
fats  as  are  also  palmitates  or  palmitins.  The  oleates  or  oleins 
on  the  other  hand  are  fluid  at  ordinary  temperatures.  It 
is  therefore  evident  that  solid  fats  contain  much  more  stearin 
or  palmitin  than  olein,  while  fat  oils  consist  chiefly  of  olein. 
Stearin  is  found  only  in  fat  of  animal  origin.  Animal  fats 
are  therefore  a  mixture  of  all  three  classes,  while  vegetable 
fats  consist  of  mixtures  of  palmitins  and  oleins.  Suet  and 
tallow  owe  their  firmness  largely  to  the  amount  of  stearin 
present,  while  lard  owes  its  softness  to  the  amount  of  olein 
present.  Butter  consists  largely  of  palmitin.  The  most 
prominent  of  the  animal  fats  are  butter,  cream,  lard,  suet, 
tallow,  butterine,  oleomargarine  and  cod-liver  oil.  The  veg- 
etable oils  are  obtained  from  fruits  and  nuts  (olive,  cotton- 
seed, peanut,  cocoanut,  cocoa  bean  and  almond).  Vegetable 
oils  and  the  liver  oil  of  fish  are  composed  chiefly  of  olein. 
Certain  dietetic  substances  not  usually  thought  of  as  fatty, 
contain  much  oil.  Some  of  these  are  yolks  of  eggs,  Indian 
corn  and  nearly  all  nuts  except  chestnuts.  Artificial  products 
like  butterine  are  described  elsewhere.  They  are  often  pre- 
ferred to  butter  because  their  melting  point  is  lowered  by  the 
addition  of  suet  or  tallow  (beef -drippings)  so  that  they  keep 
better  in  warm  weather. 

Lecithin  is  a  substance  usually  classed  with  fats  and  oils. 
Besides  fatty  acids  it  contains  phosphorus.  It  is  a  necessary 
constituent  of  every  living  cell  and  is  especially  plentiful  in 
the  nervous  tissues.    At  present  it  is  used  to  a  considerable 


NON-NITROGENOUS  FOODS 


21 


extent  in  medicine  in  the  belief  that  it  is  of  value  as  a  food- 
drug  and  reconstituent.  It  is  prepared  from  the  yolk  of  egg 
and  from  brain  substance.  Feeding  yolks  of  eggs  is  usually 
as  advantageous  and  cheaper. 

Volatile  Oils,  These^  as  already  stated,  have  little  in  com- 
mon with  true  oils.  They  stain  paper  only  temporarily, 
while  a  fat  stain  is  permanent.  They  vary  much  among 
themselves  in  composition  and  agree  chiefly  in  their  tendency 
to  disappear  by  evaporation;  and  their  odor,  taste  and  pun- 
gency. A  few  of  them  are  used  in  diet  for  flavoring.  The 
oil  of  bergamot  is  obtained  from  orange  peel,  oil  of  lemon 
from  lemon  peel,  etc.  Cooking  tends  to  volatilize  them,  so 
that  such  flavoring  should  be  added  at  the  last  moment. 

Sources  of  Fat  in  the  Diet.  The  chief  sources  of  fat  in  the 
diet  are  milk  (yielding  cream  and  butter),  olive  oil,  meat 
fats  (especially  lard,  bacon  and  salt  pork,  beef  suet  and  drip- 
pings), and  oily  nuts. 

Cheap  Forms  of  Fat.  Butter,  cream,  olive  oil,  lard,  etc., 
are  all  subject  to  adulteration  with  cheaper  fats,  but  aside 
from  the  fraud  in  charging  a  high  price  there  is  a  legitimate 
industry  for  making  cheaper  products  representing  these 
articles.  Thus  skim  milk  has  its  lost  cream  restored  by  a 
homogenized  meat  fat  containing  some  butter.  A  substitute 
for  butter  is  produced  from  animal  fats  and  sold  under  special 
names,  etc.  A  substitute  for  lard  with  a  higher  melting 
point  is  made  from  cottonseed  oil.  The  industry  is  yet  in  its 
infancy,  although  half  a  century  old.  The  more  expensive 
fats  are  prized  for  their  flavor,  but  the  cheaper  fats  care- 
fully refined  have  also  a  high  nutritive  value. 

Function.  Fats  are  burned  up  in  the  body  and  produce 
energy  in  the  form  of  work  or  heat.  According  to  Dr.  W. 
Gilman  Thompson,  the  chief  uses  of  fats  are  as  follows : 

1.  To  furnish  energy  for  the  development  of  heat. 

2.  To  supply  force. 

3.  To  serve  as  covering  and  protection  in  the  body. 

4.  To  make  more  plastic  various  structures  of  the  body  and  give 
rotundity  to  the  form. 


22 


PRACTICAL  DIETETICS 


5.  To  spare  the  tissues  from  disintegration;  for,  although  their 
combustion  in  the  body  results  largely  in  the  production  of  heat, 
they  also  take  to  some  extent  in  tissue  formation. 

6.  To  serve  for  storage  of  energy. 

Source  of  Body  Fat.  Twenty  per  cent,  of  the  normal 
weight  of  man  is  fat.  It  is  derived  mainly  from  fatty  foods 
and  carbohydrates.  Proteins  are  transformed  into  fat  only  to 
a  very  limited  degree.  It  is  most  readily  produced  from  car- 
bohydrates, or  a  mixture  of  .carbohydrates  and  fats. 

Principles  of  Cooking.  Fats  are  more  digestible  cold  than 
hot,  because  hot  fat  tends  to  coat  and  intimately  penetrate 
the  food  with  which  it  is  cooked  or  eaten,  and  as  this  coating 
is  not  dissolved  by  the  digestive  juices  of  the  mouth  or 
stomach,  little  or  no  digestion  of  carbohydrate  and  protein 
can  take  place  in  either  of  these  places  under  such  circum- 
stances. Heating  fat  to  a  high  temperature  also  changes  its 
chemical  nature,  often  producing  irritating  substances  which 
interfere  with  digestion.  For  such  reasons  fried  food  should 
never  be  given  to  invalids. 

Digestibility.  The  majority  of  fats  are  not  very  easily  di- 
gested, consequently  are  not  tolerated  by  those  suffering  from 
indigestion  or  by  patients  acutely  ill;  their  use  should  be 
limited  to  finely  divided  forms,  as  in  milk  or  yolk  of  egg; 
it  is  sometimes  even  necessary  to  reduce  the  fat  in  milk  by 
skimming  off  the  cream,  or  to  limit  the  amount  of  yolk  of 
egg,  inasmuch  as  30  per  cent,  of  the  yolk  is  fat.  Other 
forms  of  fat  valuable  in  the  invalid's  dietary  are  butter,  cod- 
liver  oil,  and  fat  bacon  cooked  crisp.  All  fats,  except  limited 
quantities  of  butter  and  cream,  should  be  forbidden  in  acute 
diseases  of  the  stomach,  intestines  and  liver,  and  in  most  of 
the  chronic  affections.  Their  use  should  be  limited  also  in 
the  presence  of  gall  stones. 

Fatty  foods  should  be  prescribed  for  children  with  rickets 
and  for  all  who  have  diabetes.  In  the  latter  disease  they 
partly  replace  the  carbohydrates  which  cannot  be  used.  Fat 
may  be  prescribed  with  benefit  in  chronic  wasting  disease, 
such  as  tuberculosis,  and  during  convalescence  from  severe 


WATER 


23 


acute  disease.  The  most  agreeable  and  digestible  forms 
should  be  given.  At  first  a  small  portion  only  should  be 
taken,  and  the  quantity  increased  in  proportion  to  a  patient's 
willingness  to  accept  it.  In  a  general  way  fats  and  oils  are 
laxative;  consequently  useful  in  case  of  constipation  and 
equally  harmful  where  there  is  a  tendency  to  diarrhoea. 

Comparative  Value  of  Fat  and  Carbohydrates  as  Fuel  Foods. 
Fats  and  carbohydrates  serve  the  same  purpose  in  the  body, 
in  that  they  furnish  energy.  Fats  are  not  as  easily  digested 
as  carbohydrates,  but  weight  for  weight  they  furnish  two  and 
one-fourth  times  as  much  energy. 

Tests  for  Fats.  Fats  are  readily  tested  with  paper;  if 
they  are  present  in  a  given  substance  a  permanent  grease- 
spot  appears.  If  to  a  suspected  substance  a  little  solution  of 
caustic  soda  is  added  a  white  precipitate  forms,  representing 
a  hard  soda  soap. 

WATER 

Composition  and  Properties.  Water  is  a  compound  of  hy- 
drogen and  oxygen,  consisting  of  two  parts  by  volume  of 
hydrogen  to  one  of  oxygen.  Absolutely  pure  water  is  color- 
less, odorless,  and  tasteless,  but  such  water  is  not  found  in 
nature,  owing  to  its  great  solvent  power,  which  causes  it  to 
dissolve  substances  with  which  it  comes  in  contact.  Water 
ordinarily,  therefore,  contains  varying  quantities  of  mineral 
and  organic  matter,  including  gases.  To  these  substances  in 
solution  the  characteristic  flavor  is  due.  Water  from  which 
the  air  has  been  expelled  by  long  standing  in  a  warm  place, 
or  by  boiling,  has  a  "  flat  taste. 

AVater  freezes  at  32°  F.  On  heating,  the  ice  melts,  and 
we  may  have  ice  water  with  a  temperature  of  32°  F.  When 
this  water  is  warmed,  the  air  dissolved  in  it  begins  to  expand, 
and  tiny  bubbles  appear,  forming  first  on  the  sides  of  the 
vessel,  and  tending  to  rise  to  the  surface.  If  the  water  there 
is  not  yet  warmed,  they  contract  and  sink,  but  finally  when 
the  water  is  warm  throughout,  come  to  the  surface  and  es- 
cape.   After  the  air  is  thus  expelled,  if  heating  is  continued. 


24 


PRACTICAL  DIETETICS 


steam  bubbles  form  in  a  similar  manner.  At  185°  F.,  water 
bubbles  below  the  surface,  or  simmers.  ^\Tien  the  bubbleg> 
reach  the  surface  and  break,  giving  off  a  cloud  of  steam,  the 
ioiling  point  has  been  reached,  212°  F.  Except  under  pres- 
sure, water  can  then  become  no  hotter.  Fast  boiling  simply 
means  rapid  evaporations  and  waste  of  fuel. 

Source  of  Water  as  Food.  A  considerable  source  of  water 
is  food  itself.  In  green  vegetables  and  fruits  it  constitutes 
as  high  as  85  to  95  per  cent,  of  the  whole  substance;  in 
potatoes  and  other  starchy  vegetables  it  is  present  in  as  large 
amount  as  75  per  cent.  Even  in  seemingly  dry  foods,  as 
crackers,  there  may  be  as  much  as  5  to  10  per  cent.  But 
since  60  per  cent,  of  the  body  itself  is  composed  of  water,  and 
water  loss  through  the  lungs,  skin,  kidneys,  etc.,  is  very  con- 
stant, the  supply  in  ordinary  diet  is  not  sufficient,  and  water 
must  be  added  as  a  beverage.  This  may  be  in  the  form  of 
ordinary  drinking  water,  of  tea,  coffee,  or  other  similar  bev- 
erages and  of  medicinal  waters;  the  latter,  however,  should 
be  considered  chiefly  under  the  head  of  drugs. 

Functio7is  of  Water  in  the  Body.  Water  undergoes  no 
chemical  change  in  the  body,  yet  the  consideration  of  it  is  of 
vital  importance.  Solution  is  an  essential  part  of  digestion. 
Water  bathes  the  tissues  and  washes  away  our  waste  and  ex- 
crementitious  matter.  As  it  does  not  itself  undergo  any 
chemical  alteration  it  is  not  susceptible  of  liberating  force, 
consequently  is  not  an  energy-producing  agent,  but  contributes 
to  chemical  changes  by  supplying  a  necessary  condition  for 
their  occurrence. 

Dr.  Oilman  Thompson  summarizes  the  uses  of  water  in  the 
body  as  follows: 

1.  It  enters  into  the  chemical  combination  of  the  tissues. 

2.  It  forms  the  chief  ingredient  of  all  the  fluids  of  the  body  and 
maintains  their  proper  degree  of  dilution. 

3.  By  moistening  various  surfaces  of  the  body,  such  as  the  mucous 
and  serous  membranes,  it  prevents  friction  and  the  uncomfortable 
symptoms  which  might  result  from  their  drying. 

4.  It  furnishes  in  the  blood  and  lymph  a  fluid  medium  by  which 


WATER 


25 


food  may  be  taken  to  remote  parts  of  the  body  and  the  waste  material 
removed,  thus  promoting  rapid  tissue  changes. 

5.  It  serves  as  a  distributor  of  body  heat. 

6.  It  regulates  the  body  temperature  by  the  physical  processes  of 
absorption  and  evaporation. 

Professional  fasters  have  shown  that  one  may  live  for 
weeks  without  food^  but  it  may  readily  be  demonstrated  that 
a  warm-blooded  animal  except  in  a  state  of  hibernation  or 
trance  can  subsist  but  a  few  days  without  water. 

Food  Uses  of  Water.  Water  taken  in  considerable  quan- 
tities with  meals  favors  upward  metabolism  and  increases  the 
utilization  of  food.  Thirst  at  meals  does  not  always  mean 
a  true  body  demand  for  water,  as  it  may  be  due  to  condiments, 
or  to  improper  mastication  of  food.  Under  ordinary  circum- 
stances, about  three  or  four  pints  daily  are  necessary  to  make 
up  loss  of  water  that  is  constantly  being  eliminated  through 
the  skin,  kidneys,  lungs  and  intestines.  The  quantity  ex- 
creted daily  varies  greatly  under  special  conditions.  The  de- 
mand for  water  is  much  increased  by  hot  weather,  and  vio- 
lent exercise,  and  diminished  in  the  bedridden  and  sedentary. 
Babies,  delirious  patients,  etc.,  should  be  fed  water,  as  care- 
fully as  other  food. 

Classification  of  Varieties  of  DrinTcing  Waters,  The  clas- 
sification of  water  as  food  is  based  chiefly  on  its  purity  and 
palatability. 

Hard  and  Soft  Water.  Water  containing  calcium  (lime) 
or  magnesium  salts  is  known  as  hard  water ;  and  if  it  contains 
these  salts  in  excess  it  is  unsuited  not  only  for  drinking 
but  for  cooking  and  bathing,  unless  purified  or  softened.  As 
only  the  carbonates  can  be  expelled  from  the  water,  the  purifi- 
cation is  incomplete;  chlorides  and  sulphates  remain  behind. 
For  washing  purposes  the  carbonate  of  lime  may  be  precipi- 
tated by  treating  with  lye,  whereupon  it  rises  to  the  surface 
and  can  be  skimmed  off.  By  adding  soda  to  cooking  water, 
a  similar  softening  is  obtained  desirable  in  cooking  vegetables, 
as  they  are  toughened  by  the  lime  and  sodium  chloride. 
Finally,  for  drinking  purposes  hard  water  may  be  subjected 


26 


PRACTICAL  DIETETICS 


to  prolonged  boiling  and  straining;  by  this  means  the  car- 
bonic acid  is  driven  off  and  the  lime  is  set  free.  It  must  be 
remembered  that  a  water  not  suited  for  domestic  uses  may 
still  be  fit  for  drinking  if  not  taken  in  great  excess^  because 
lime  and  magnesium  are  natural  ingredients  of  the  body. 

In  soft  water  only  a  small  amount  of  salts  are  found  and 
as  a  rule  it  is  more  desirable  to  use  for  cooking  purposes, 
especially  in  the  cooking  of  legumes  or  when  the  object  is 
to  extract  the  nourishment  or  flavor  of  food^  as  in  making 
tea  or  soup,  etc. 

Eain  water  is  naturally  pure  but  devoid  of  any  mineral 
content,  which  is  sometimes  a  disadvantage.  It  is  not  very 
palatable.  It  should  be  remembered  that  the  first  part  of  a 
rain  fall  carries  down  with  it  dust  and  impurities  from  the 
air,  but  the  latter  part  of  a  shower  furnishes  as  pure  water 
as  can  be  found  from  any  source. 

Spring  Water,  well  water,  etc.,  vary  greatly  in  the  amount 
of  mineral  matter,  organic  matter,  gases,  etc.,  present.  In 
many  cases  the  mineral  content  or  gas  content  is  such  as  to 
confer  a  medicinal  value.  In  other  cases  the  mineral  matter 
is  a  menace  to  health.  In  most  ground-water  there  is  organic 
matter  which  besides  being  undesirable  in  itself  invites  the 
presence  of  germs,  which  often  threaten  the  health  and  safety 
of  whole  communities.  Great  care  should  be  taken  as  to  the 
location  of  a  well ;  deep  spring  water  and  water  from  artesian 
w^ells  is  usually  pure.  City  water  is  usually  filtered  through 
sand  beds  and  otherwise  purified ;  the  law  requires  such  waters 
to  be  frequently  analyzed  as  to  purity. 

As  water  may  dissolve  the  lead  from  pipes  through  which 
it  flows,  it  should  be  allowed  to  run  several  minutes  before 
using  if  it  has  not  been  recently  run  off  (as  after  standing 
over  night)  to  avoid  the  risk  of  lead  poisoning. 

Filtered  Water  is  water  freed  from  organic  matter  of  all 
kinds.  It  should  be  pure  and  palatable.  But  filtered  water 
as  a  rule  cannot  be  depended  upon  for  purity  owing  to  the 
fact  that  the  domestic  filters  require  constant  cleansing  and 


WATER 


serve  to  condense  the  impure  organic  matter  which  putrefies 
upon  the  filter  and  renders  the  water  passed  through  them 
fouler  in  place  of  purer.  Small  filters  screwed  on  fau- 
cets are  of  no  value  whatever.  There  are  charcoal  and 
porcelain  filters  on  the  market  that  are  very  good,  but  are 
not  effective  unless  often  and  thoroughly  cleansed.  When 
there  is  the  least  doubt  as  to  the  purity  of  water  it  is  best  to 
boil  it. 

Boiled  Water.  Water  simply  sterilized  by  boiling  and 
kept  in  bottles  in  a  cool  place  is  extensively  used  when  there 
is  suspicion  as  to  its  purity.  It  is  rather  unpalatable.  Boil- 
ing renders  harmless  all  the  organic  impurities  and  precipi- 
tates salts  of  lime.  It  must  always  be  borne  in  mind  that 
typhoid  fever,  cholera,  dysentery  and  other  pestilences  are 
largely  water-borne  diseases,  and  whenever  there  is  any  sus- 
picion that  water  is  contaminated,  the  most  available  method 
for  purification  is  boiling.  Before  filling  the  bottles,  have 
them  thoroughly  cleansed  and  rinse  with  boiling  hot  water, 
as  a  few  drops  of  unboiled  water  would  be  sufficient  to  con- 
taminate the  whole.  To  prevent  breaking,  place  bottles  in 
pan  of  warm  water  before  pouring  in  the  boiling  water. 

Distilled  Water.  This  is  water  in  its  purest  state.  It  is 
said  by  many  authorities  to  be  unsuited  for  a  beverage  be- 
cause of  total  absence  of  mineral  matter  and  gases,  on  ac- 
count of  which  mineral  matter  is  greedily  abstracted  from 
the  walls  of  the  stomach,  thereby  causing  congestion  and  irri- 
tation. It  is  generally  used  for  medicinal  and  chemical  pur- 
poses. If  employed  as  a  beverage  it  should  be  aerated  to 
improve  the  flavor. 

Carbonated  Waters.  Ordinary  water  may  be  artificially 
charged  with  carbon  dioxid,  as  soda  water,  etc.  Among  the 
most  common  carbonated  waters  (naturally  charged)  are 
Vichy,  White  Kock  Water  and  Seltzer  (effervescing  waters) 
and  Poland  water  (uneffervescing).  These  are  valuable  in 
case  of  fever  and  to  tempt  people  to  drink  more  water ;  also  in 
relieving  nausea  and  vomiting.  They  are  used  to  advantage 
with  acid  drinks  and  to  dilute  alcoholic  liquors.  Carbonated 


28 


TRACTICAL  DIETETICS 


water  of  any  kind  should  not  be  taken  in  excess^  as  such  waters 
are  apt  to  produce  indigestion^  by  retarding  the  action  of  the 
gastric  juice. 

Alkaline  Mineral  Waters  are  carbonated  (naturally 
charged)  and  differ  from  ordinary  water  in  the  greater 
amount  of  gaseous  (carbon  dioxid  and  sulphuretted  hydro- 
gen) and  solid  matter  (sodium  chloride,  potassium,  magne- 
sium, iron,  sulphur,  etc.,  etc.),  which  they  contain.  Some 
mineral  waters  have  no  medicinal  value  and  are  simply  used 
for  quenching  thirst;  others  have  purgative,  laxative  or  diu- 
retic effect.  The  following  are  a  few  examples  of  the  latter 
class  —  Sulphur  Springy  Saratoga,  Yichy,  Hunyadi,  London- 
derry, and  Lithia  Waters. 

The  benefit  derived  from  the  water  cures  so  often  pre- 
scribed is  not  usually  from  the  water  itself  but  from  the 
change,  treatment  and  quantity  of  water  taken.  Much  bene- 
fit can  be  derived  by  following  the  same  treatment  at  home. 

Temperature  of  Drinking  Water.  Luke-warm  or  tepid 
water  (65°  to  92°  F.)  which  in  theory  should  be  most  suited 
for  drinking  is  insipid  and  even  repugnant  to  most  people. 
Hence  as  a  beverage  water  is  either  taken  warm  (92°  to  100° 
F.),  hot  (100°  F.  and  over),  cool  (65°  to  92°  F.)  or  cold  (32° 
to  65°  F.).  The  taking  of  hot  w^ater  in  large  quantities  has 
been  found  of  benefit  for  weak  digestions  and  in  much  chronic 
invalidism.  It  acts  as  a  stimulant  to  gastric  digestion;  re- 
lieves thirst  more  quickly  than  cold  water ;  is  more  quickly  ab- 
sorbed, and  leaves  the  stomach  sooner.  Cool  water  is  the  nor- 
mal beverage  for  quenching  thirst.  Ice  water  is  unsuitable 
for  all  individuals  when  overheated,  and  with  meals  for  dys- 
peptics and  those  in  delicate  health.  Fever  patients,  however, 
may  take  it  ad  libitum ;  for  most  robust  individuals  who  crave 
it  with  or  without  meals  it  seems  to  do  no  great  harm,  if  taken 
slowly  and  in  moderation.  Its  coldness  acts  as  a  natural 
check  against  overindulgence.  It  probably  slows  the  move- 
ments of  the  stomach  and  as  long  as  the  stomach  is  chilled 
the  action  of  the  pepsin  is  curtailed  since  this  acts  best  near 


MINERAL  MATTER 


29 


blood  temperature,  but  the  arrest  is  only  temporary.  A  small 
quantity  of  crushed  ice  is  known  to  relieve  nausea. 

MINERAL  MATTER 

Function,  The  mineral  matter  in  the  body  serves  the 
most  varied  ends.  It  gives  solidity  to  the  bones  and  teeth; 
its  presence  in  body  fluids,  such  as  blood  and  l3niiph,  im- 
parts to  them  a  certain  degree  of  concentration  which  is  abso- 
lutely necessary  to  the  vital  processes.  Again,  minute  quan- 
tities of  mineral  matter  are  invariably  present  in  living  cells 
and  are  indispensable  to  their  existence.  The  kind  of  min- 
eral matter  in  a  given  tissue  or  organ  varies  according  to  its 
function.  The  bones  and  teeth  owe  their  stability  to  salts 
of  calcium  (lime)  and  magnesium,  especially  the  phosphates. 
The  salts  which  are  necessary  for  the  regulation  of  the  body 
fluids  comprise  potassium,  sodium,  calcium  and  magnesium, 
especially  in  the  form  of  chlorides.  The  substances  essential 
to  the  active  cells  as  part  of  their  normal  structure  comprise 
phosphorus,  iron,  and  sulphur,  in  the  form  of  organic  com- 
pounds, along  with  other  salts  in  small  quantities.  Phos- 
phorus is  found  in  the  nuclei  of  all  cells  and  is  essential  for 
growth.  The  red  corpuscles  are  rich  in  iron,  and  the  thyroid 
gland  cells  contain  considerable  iodin.  Nearly  all  cells  have 
traces  of  sulphur,  mainly  in  the  form  of  protein. 

Amount  and  Kind  of  Mineral  Matter  in  the  Organism, 
The  mineral  matter  in  the  body  amounts  to  about  5  or  6 
per  cent,  by  weight,  occurring  chiefly  in  the  bones.  The  ele- 
ments needed  in  the  body  can  all  be  found  in  food. 

The  chemical  elements  found  in  the  body  comprise  hydro- 
gen^ oxygen,  nitrogen,  carbon,  phosphorus,  sulphur,  silicon, 
fluorin,  chlorin,  iodin,  all  of  the  non-metal  type ;  while  of  the 
metals  are  present  sodium,  potassium,  calcium,  magnesium, 
iron.  Traces  of  manganese,  aluminium,  possibly  also  arsenic, 
are  sometimes  found.  Any  substance  which  exists  in  the  soil 
may  find  its  way  into  the  body. 


30 


PRACTICAL  DIETETICS 


There  is  more  calcium  (lime)  in  the  body  than  any  other 
of  the  metals,  while  phosphorus  exists  to  a  greater  extent 
than  any  other  non-metallic  element,  exclusive  of  those  which 
go  to  form  living  matter.  These  elements  predominate  thus 
because  the  bones  contain  so  large  an  amount  of  phosphate 
of  lime.  Lime  is  also  present  to  a  considerable  extent  as  car- 
bonate. Magnesiimi  phosphate  comes  next  in  amount.  With 
the  exception  of  these  three  bone  compounds,  mineral  matter 
is  present  in  relatively  small  quantities. 

The  sodium  and  chlorin  occur  chiefly  in  the  form  of  sodium 
chlorid,  which  is  present  in  all  the  fluids  and  solids.  The 
chlorin  of  hydrochloric  acid  of  the  gastric  juice  comes  from 
the  sodium  chlorid.  Some  sodium  is  also  present  as  car- 
bonate and  phosphate,  and  these  two  are  found  in  sufficient 
amount  to  give  the  blood  and  numerous  fluids  and  secretions 
a  neutral  reaction.  Potassium  occurs  mainly  in  the  form 
of  potassium  phosphate.    Muscle-tissue  is  rich  in  this  salt. 

The  sulphur  and  phosphorus  which  enter  the  body  in  the 
form  of  protein  in  animal  food  are  oxidized  to  sulphuric 
and  phosphoric  acids  and  these  at  once  combine  with  bases 
to  form  sulphates  and  phosphates  of  lime,  sodium,  etc. 
Sulphates  occur  to  a  slight  extent  only,  while  as  already  stated 
phosphates  are  the  most  important  constituents  numerically. 

Source  of  Mineral  Matter  in  the  Food.  The  mineral  mat- 
ter received  into  the  body  comes  either  from  the  solid  food 
or  dietetic  fluids.  With  the  exception  of  sodium  chlorid 
(common  salt)  it  is  not  usually  added  to  the  diet.  Such  ad- 
ditions, however,  are  often  prescribed  as  medicine  in  states 
of  ill  health.  Thus  phosphates  and  hypophosphites  of  lime, 
sodium  and  potassium  are  used  largely  in  rickets  and  scrofula. 
Iron  is  given  for  impoverished  blood.  It  is  better  to  give 
them  in  the  form  of  food  as  far  as  possible,  and  care  should 
be  taken  to  see  that  the  food  is  rich  in  the  mineral  elements 
needed  even  if  they  are  at  the  same  time  being  given  in  in- 
organic form,  for  the  body  can  use  food  salts  in  many  in- 
stances to  much  greater  advantage. 

Animal  food  in  general  contains  the  same  mineral  con- 


MINERAL  MATTER 


31 


stituents  that  are  found  in  corresponding  human  tissues. 

CoVs  milk  is  rich  in  calcium  and  phosphorus  in  organic 
forms^  and  contains  small  amounts  of  sodium^  potassium^, 
magnesium,  iron  and  chlorin. 

Eggs  contain  iron  and  phosphorus  in  their  most  assimilable 
forms,  especially  in  the  yolks. 

Meats  are  lacking  in  calcium,  and  while  red  meats  are 
comparatively  rich  in  iron,  it  is  not  in  as  available  form  as 
in  eggs. 

Since  the  animals  used  by  us  as  food  obtain  their  mineral 
matter  from  plants,  the  richest  and  most  varied  supply  is  com- 
monly found  in  the  vegetable  kingdom.  Calcium  is  abundant, 
especially  in  such  vegetables  as  beans  and  peas,  fresh  or  dried, 
in  other  green  vegetables,  in  fruits  and  the  outer  parts  of 
grains.    There  is  little  in  polished  rice  or  fine  flour. 

A^egetable  foods  are  rich  in  potassium,  which  usually  oc- 
curs in  the  form  of  potassium  phosphates.  Spinach  is  richer 
in  iron  than  almost  any  other  plant  food;  whole  wheat,  oat- 
meal, peas  and  beans,  raisins  and  prunes  are  also  valuable 
sources  of  organic  iron. 

Vegetable  Acids  and  their  Salts.  Some  authorities  con- 
sider these  substances  under  the  head  of  mineral  matter, 
although  they  have  an  organic  origin  and  do  not  pre-exist 
in  the  soil.  They  comprise  the  acids  of  juicy  fruits  such  as 
the  citric  acid  of  the  citrus  group,  the  malic  acid  of  apples, 
pears,  etc.,  and  the  tartaric  acid  of  grapes.  They  exist  partly 
in  a  state  of  combination  with  sodium  and  potassium.  Prom 
a  dietetic  standpoint  they  may  be  placed  in  the  same  category 
as  the  carbonic  acid  gas  and  alkaline  carbonates  of  the  diet, 
because  in  the  body  they  quickly  become  changed  to  car- 
bonates, and  assist  in  the  maintenance  of  the  proper  reaction 
of  the  blood.  Various  diseases  are  believed  to  be  due  to  an 
excess  of  acid  in  the  body,  or  what  is  the  same  thing,  to  a 
diminution  of  alkali.  There  is  no  doubt  that  acid  fruits 
and  vegetables  are  valuable  in  counteracting  such  a  condi- 
tion. 

Importance  of  a  Proper  Supply  of  Mineral  Matter,  It 


32 


PRACTICAL  DIETETICS 


was  formerly  thought  that  since  mineral  matter  is  universally 
present  in  food  and  drink^  an  individual  need  pay  little  at- 
tention to  this  phase  of  the  feeding  problem.  Before  the 
paths  of  elimination  of  ash  constituents  had  been  studied  with 
any  care^  it  was  assumed  that  many  such  compounds  were 
excreted  in  the  feces  without  having  ever  been  absorbed. 
Since  more  light  has  been  thrown  on  the  fact  that  the  in- 
testines form  the  regular  path  of  excretion  of  certain  mineral 
matter^  and  on  the  chemical  nature  of  the  regulation  of  body 
processes,  there  has  been  greater  realization  of  the  fact  that 
unless  a  diet  is  chosen  from  a  wide  range  of  food  materials, 
these  is  danger  of  some  of  these  constituents  being  supplied  in 
too  small  quantities  or  not  at  all.  This  is  especially  true  in 
the  case  of  artificially-fed  infants  and  of  growing  children, 
whose  demand  for  building  material  is  large^  but  it  is  not 
negligible  even  in  adults,  especially  for  the  proper  control 
of  the  body  processes.  If  care  is  taken  to  provide  iron, 
phosphorus  and  calcium  in  organic  forms,  there  is  little  dan- 
ger of  inadequate  supply  of  the  inorganic  salts,  since  these 
are  present  in  the  milk,  eggs,  green  vegetables  and  fruits 
which  best  supply  the  elements  mentioned  above. 

Use  of  Mineral  Matter  in  Disease,  Continued  depriva- 
tion of  sodium  chlorid  (common  salt)  will  finalty  lead  to 
lowered  secretion  of  hydrochloric  acid  in  the  gastric  juice, 
but  there  are  certain  diseased  conditions  in  which  withhold- 
ing of  salt  is  beneficial.  Salt  tends  to  hold  water  in  the 
body,  and  where  the  heart  is  weak,  and  it  is  desirable  to 
lessen  the  volume  of  blood  to  be  pumped,  a  salt-free  diet  may 
be  desirable.  In  some  forms  of  edema  and  in  Bri'ght^s  dis- 
ease the  practice  is  also  followed.  Epileptics  who  depend 
upon  bromides  to  prevent  their  fits  can  do  with  much  less  of 
these  substances  if  their  salt  is  cut  down,  because  bromin  up 
to  a  certain  extent  displaces  the  chlorin  in  such  compounds  as 
sodium  chlorid,  and  fails  to  fulfill  its  purpose  in  such  a  case. 

It  is  common  to  find  statements  that  certain  serious  dis- 
orders like  calculus  disease,  rickets,  scurvy^  tuberculosis,  etc., 
are  due  primarily  to  too  much  or  too  little  of  some  mineral; 


FOOD  ACCESSORIES  OR  ADJUNCTS  33 


but,  as  already  stated;,  the  real  causes  must  lie  deeper,  al- 
though the  possibility  of  such  factors  must  never  be  under- 
rated. Scurvy  was  once  held  to  be  due  to  too  much  salt, 
used  as  preservatives;  later  it  was  regarded  as  due  less  to 
excess  of  some  salts  than  absence  of  others,  as  potassium. 
To-day  we  believe  it  is  due  to  something  provided  by  fresh 
food,  but  destroyed  sometimes  by  drying  and  sometimes  by 
cooking.  With  a  more  liberal  dietary,  including  fresh  vege- 
tables and  fruits,  it  disappears. 

Beriberi,  a  disease  produced  by  a  dietary  composed  largely 
of  polished  rice,  has  been  shown  to  be  due  to  the  absence  of 
minute  quantities  of  a  complex  organic  compound  present  in 
the  rice  bran.  Addition  of  this  to  a  polished  rice  diet  will 
effect  a  cure.  Students  of  nutrition  are  looking  for  other 
substances  of  this  class,  in  other  foods.  It  has  been  shown 
that  butter  fat  contains  something  necessary  to  the  growth  of 
)^oung  animals  (white  rats)  which  is  found  also  in  cod  liver 
oil,  but  not  in  lard.  The  term  vitamine  is  proposed  for  these 
as  yet  little  known  but  evidently  important  substances. 

Children  with  rickets  often  improve  on  preparations  con- 
taining lime  and  sodium,  as  also  do  scrofulous  children,  but 
it  is  difficult  to  show  that  in  such  cases  the  remedies  act  by 
supplying  any  one  kind  of  mineral  food.  The  safe  war 
ia  to  supply  foods  containing  all,  unless  one  has  positive 
knowledge  of  the  value  of  some  specific  element. 

FOOD  ACCESSORIES  OR  ADJUNCTS 

CONDIMENTS  —  BEVERAGES 
CONDIMENTS 

Condiments  are  substances  not  necessarily  possessing  nutri- 
tive value,  which  are  used  to  give  sapidity  to  tasteless  or  un- 
appetizing dishes.  To  what  extent  they  have  any  specific 
action  on  the  functions  of  the  body  is  not  clear.  They  tend 
to  increase  the  flow  of  saliva  and  gastric  juice  and  thus  in 
theory  favor  the  digestion  of  starch. 

Classification.    The  number  of  condiments,  if  we  include 


34 


PRACTICAL  DIETETICS 


appetizing  substances  of  all  kinds,  is  very  large.  In  some 
countries  olives,  a  bit  of  dried  herring,  in  fact,  anything  pos- 
sessing pungency,  may  be  served  before  a  regular  meal. 

Sauces  perhaps  represent  the  largest  class  of  condiments 
and  the  great  number  and  variety  of  their  ingredients  give 
us  some  idea  of  the  number  of  individual  condiments.  They 
are  added  to  food  while  eating. 

Spices  (ginger,  cinnamon,  nutmeg  and  cloves)  are  used 
only  in  cooking.  In  this  same  category  may  be  placed  flavor- 
ing extracts. 

Mustard  is  used  both  in  preparing  food  and  as  an  accessory 
while  eating.  Horseradish  belongs  in  the  same  class.  The 
flavor  of  these  depends  on  a  volatile  oil  peculiar  to  each  sub- 
stance. Such  oils  have  no  value  as  foods.  Pepper,  salt  and 
vinegar  form  the  most  indispensable  of  table  condiments. 
Of  these,  salt  is,  strictly  speaking,  a  food.  Wlien,  however,  it 
is  used  in  excess  of  body  needs,  simply  to  modify  the  flavor 
of  food,  it  is  properly  classed  as  a  condiment. 

Condiments  are  taken  for  their  mild  stimulating  effects  on 
the  tissues  with  which  they  come  in  contact.  They  are  not 
required  by  a  normal  appetite,  but  are  frequently  used  to 
obscure  the  flavor  of  poorly  prepared  food.  Just  as  bread  can 
be  made  of  so  delicate  a  flavor  that  it  can  be  eaten  without 
butter,  most  other  foods  can  be  so  treated  as  to  have  a  suffi- 
cient sapidity.  In  the  Northern  States,  tomatoes  and  melons 
are  eaten  with  various  accessories ;  in  some  parts  of  the  South 
such  fruits  have  so  delicious  a  flavor  that  they  are  eaten  plain. 
To  add  a  cheap  table  sauce  to  a  costly  steak  seems  a  gas- 
tronomic sin  and  certainly  has  no  physiological  justification. 

In  short,  the  taste  for  condiments  is  largely  an  artificial 
one,  and  their  use  should  be  limited.  A  well-trained  palate 
tires  of  these  high  seasonings  more  quickly  than  of  the  mild 
characteristic  flavors  of  food  perfect  in  its  natural  state  or 
so  cooked  as  to  develop  its  inherent  taste.  The  moderate  use 
of  condiments  occasionally,  for  the  sake  of  variety,  or  when 
the  appetite  is  feeble,  may  be  legitimate.  They  should  be 
withheld  (with  the  exception  of  salt),  from  the  food  of  chil- 


FOOD  ACCESSORIES  OR  ADJUNCTS 


35 


dren,  both  because  they  destroy  the  appetite  for  milder  foods, 
and  because  they  are  irritating  to  the  mucous  membrane  of 
the  alimentary  canal.  Because  of  their  irritant  properties 
they  should  also  be  given  with  caution  to  invalids,  especially 
those  suffering  from  any  inflammation  of  the  digestive  tract. 

BEVERAGES 

These  food  accessories  comprise  milk,  coffee,  tea,  cocoa 
and  chocolate,  alcoholic  drinks,  lemonade  and  other  acid 
drinks,  aerated  and  carbonated  drinks.  Milk  is  a  food 
rather  than  a  beverage,  becoming  a  solid  instead  of  a  liquid 
food  in  the  stomach.  It  is  the  only  product  in  nature  pro- 
vided solely  for  food.  It  contains  not  only  protein,  fat,  and 
carbohydrates  in  good  proportions,  but  also  a  rich  supply  of 
mineral  salts  in  an  available  form.  Growing  children  should 
have  at  least  a  quart  of  milk  every  day.  Cocoa  and  chocolate 
are  also  valuable  for  their  content  of  protein,  fat,  and  car- 
bohydrate, and  drinks  from  fruit  juices  contain  mineral  salts, 
organic  acids  (which  help  to  maintain  the  neutrality  of  the 
blood),  and  some  caj-bohydrate.  In  other  cases,  the  value  of 
beverages  does  not  lie  in  their  nutritive  content. 

Stimulation.  Coffee,  tea,  chocolate  and  cocoa  contain  a 
stimulating  alkaloid  which  produces  mild  exhilaration  without 
reaction.  Alcoholic  drinks  while  they  tend  to  produce  nar- 
cotic effects  when  taken  in  excess,  act  as  stimulants  and  ap- 
petizers in  small  quantities. 

Thirst  Quenching.  Substances  like  lemonade,  ginger  ale, 
and  aerated  drinks  in  general  use  are  used  for  this  purpose. 

Sapidity.  Coffee  and  its  congeners  are  used  largely  for 
their  delicate  flavor,  and  this  may  be  said  to  a  certain  degree 
of  all  beverages.  Drinks  especially  designed  for  the  invalid 
and  the  sick  will  be  considered  under  other  heads. 


CHAPTER  II 


NUTRITION 

DIGESTION  —  ABSORPTION  —  METABOLISM 

Under  this  term  is  usually  understood  the  digestion  and 
absorption  of  nourishment,  its  assimilation  and  utilization, 
its  storage  in  excess,  and  finally  the  elimination  of  the 
products  of  wear  and  tear,  of  combustion,  and  of  nutriment 
or  waste  which  cannot  be  utilized.  Those  processes  of  nutri- 
tion which  occur  after  absorption  are  now  included  in  the 
term  metabolism.  To  restate  this  in  a  simple  form  (adapted 
from  Thompson),  nutrition  involves: 

1.  The  secretion  of  digestive  fluids,  and  their  action  upon 
food  in  the  alimentary  canal  —  in  other  words,  digestion. 

2.  The  passage  of  the  ingredients  of  the  digested  food  into 
the  blood  vessels  and  lymphathic  vessels  —  absorption. 

3.  The  utilization  of  the  absorbed  nutrition  products  by 
the  cells  —  assimilation  or  upward  metabolism. 

4.  The  elimination  of  waste  material  —  disassimilation  or 
downward  metabolism. 

The  subjects  of  digestion  and  absorption  will  be  treated  in 
detail  for  each  food  principle,  and  then  summarized  at  the 
end  of  each  topic. 

DIGESTION 

DIGESTION  OF  PROTEINS 

Digestion  in  the  Stomach,  Protein  is  not  chemically  al- 
tered in  the  mouth.  The  process  of  chewing  simply  mois- 
tens and  divides  it  into  small  particles  so  that  it  is  easily 
swallowed  and  more  readily  attacked  by  the  secretion  of  the 
stomach.    Passing  down  the  oesophagus,  through  the  cardiac 

36 


DIGESTION 


37 


sphincter  guarding  the  entrance  to  the  stomach,  it  enters  that 
portion  of  the  latter  organ  called  the  fundus.  Here  it  rests 
quietly  for  some  time,  so  that  it  is  not  immediately  mixed 
with  gastric  juice,  as  formerly  taught,  but  the  outer  portions 
of  the  mass  are  successively  attacked  and  dissolved.  These 
soft  portions  are  then  pressed  into  the  intermediate  and 
pyloric  regions  of  the  stomach  and  subjected  to  a  thorough 
mixing. 

The  gastric  juice  is  an  acid  fluid  which  may  be  secreted  in 
large  quantities  —  as  much  as  one  or  two  gallons  in  24  hours. 
Its  acidity  is  due  to  the  presence  of  about  0.2  per  cent,  to  0.4 
per  cent,  of  hydrochloric  acid.  This  of  itself  is  capable;  of 
causing  protein  to  swell  and  to  some  extent  dissolve;  of 
hydrolyzing  the  collagen  of  connective  tissue ;  of  decalcifying 
bone ;  and  of  preventing  bacterial  action. 

The  gastric  juice  contains  two  enzymes  which  act  on  pro- 
tein, pepsin  and  rennin.  Pepsin  can  act  only  in  the  presence 
of  a  definite  percentage  of  hydrochloric  acid,  while  rennin 
acts  in  a  neutral  solution.  The  relations  of  rennin  and  pep- 
sin are  not  yet  very  clearly  understood.  The  function  of 
rennin  is  to  curdle  milk,  which  causes  it  to  remain  in  the 
stomach  long  enough  to  be  digested  by  the  pepsin. 

Action  of  Pepsin.  The  protein  of  the  diet,  more  or  less 
swollen,  softened,  and  dissolved  by  the  action  of  hydrochloric 
acid,  is  changed  chemically  by  pepsin,  into  a  series  of  in- 
creasingly simpler  and  more  soluble  products,  namely,  acid 
proteins,  proteoses  (often  called  albumoses)  and  peptones. 
The  change  to  peptones  is  not  complete,  but  these  three 
products  of  peptic  digestion  tend  to  pass  together  into  the 
intestine,  when  the  pyloric  sphincter  which  guards  the  en- 
trance to  the  duodenum  opens  to  let  them  pass.  The  opening 
and  closing  of  this  sphincter  is  controlled  by  two  factors: 
1.  The  consistency  of  the  partly  digested  food,  solid  particles 
tending  to  keep  the  pylorus  closed.  2.  The  presence  of  free 
hydrochloric  acid  in  the  stomach  contents.  This  is  the  more 
important  factor. 

Protein  is  capable  of  absorbing  and  uniting  chemically  with 


38 


PRACTICAL  DIETETICS 


a  certain  amount  of  acid.  When  it  is  so  saturated,  free  acid 
will  be  present,  having  now  nothing  with  which  to  combine, 
and  this  free  acid  is  the  stimulus  which  causes  the  pyloric 
sphincter  to  relax  and  lets  a  little  spurt  of  food  into  the 
duodenum.  Once  in  the  duodenum,  this  same  acid  acts  as 
the  stimulus  to  close  the  pylorus,  and  no  more  food  enters  the 
duodenum  until  the  first  portion  has  been  neutralized. 

A  clear  understanding  of  the  way  in  which  the  pyloric 
sphincter  is  regulated  throws  considerable  light  on  stomach 
digestion.  We  can  understand  why  a  certain  quantity  of  in- 
digestible residue,  such  as  is  present  in  most  of  our  staple 
foods  —  meats,  vegetables,  fruits,  etc. —  is  of  service  in  re- 
taining food  within  the  stomach  for  a  time,  giving  the 
hydrochloric  acid  a  chance  to  exercise  its  bactericidal  power, 
and  favoring  thorough  gastric  digestion.  It  also  explains 
why  a  meal  of  "  bolted  ^'  food  (or  of  food  imperfectly  masti- 
cated through  absence  of  teeth),  or  a  failure  of  free  hydro- 
chloric acid  in  the  stomach  contents,  as  in  hypoacidity  or 
achylia  gastrica,  may  set  up  such  a  continuous  state  gf  pyloric 
contraction  that  the  stomach  remains  unemptied  for  a  long 
period,  with  a  good  prospect  of  fermentation  and  gas  pro- 
duction, of  relief  by  vomiting,  or  of  an  attack  of  acute  in- 
digestion, biliousness  or  diarrhoea.  The  nurse  will  under- 
stand why  a  diet  of  liquids  for  a  person  in  relatively 
good  health  does  not  prove  satisfactory.  Liquids  do  not  stay 
long  enough  in  the  stomach  to  give  a  sense  of  fullness,  give 
the  stomach  little  to  do,  and  tend  to  pass  into  the  intestine 
poorly  prepared  for  the  action  of  the  digestive  juices  there. 

Digestion  in  the  Intestines.  On  entering  the  duodenum, 
the  acid  chyme  from  the  stomach  meets  three  secretions,  all 
alkaline  in  reaction,  namely,  the  pancreatic  juice,  the  hile, 
and  the  intestinal  juice. 

The  hydrochloric  acid  of  the  stomach  is  indirectly  respon- 
sible for  the  flow  of  the  pancreatic  juice,  for  this  begins  only 
after  acid  food  has  entered  the  duodenum.  The  pancreatic 
juice  contains  an  enzyme  capable  of  digesting  protein  only 
after  it  has  come  into  contact  with  the  intestinal  juice.  This 


DIGESTION 


39 


enzyme  is  then  called  trypsin,  and  the  changes  which  it  pro- 
duces in  protein  are  similar  to  those  produced  by  pepsin;  it 
acts,  however,  in  an  alkaline  medium. 

The  products  of  tryptic  digestion  are  therefore  alkali  pro- 
tein,  proteoses  (albumoses)  and  peptones. 

The  bile  plays  no  significant  part  in  protein  digestion,  ex- 
cept as  it  helps  to  neutralize  the  chyme. 

The  intestinal  juice  contains  an  enzyme  called  erepsin, 
which  completes  the  digestion  of  protein,  breaking  down  the 
proteoses  and  peptones  formed  by  pepsin  and  trypsin  into 
still  less  complex  compounds  called  amino  acids.  These  are 
the  "  end-products  of  protein  digestion.  The  digestive 
process  can  go  no  farther.  There  are  no  enzymes  acting  on 
proteins  in  the  large  intestines. 

Summary,  The  chemical  changes  in  protein  during  the 
process  of  digestion  are  shown  in  the  following  table : 


PART  OF 
ALIMENTARY 
TRACT 

NAME 
OF 

SECRETION 

ENZYMES 
ACTING  ON 
PROTEIN 

PRODUCTS  OF 
ENZYME  ACTION 

:Mouth 

Saliva 

None 

None 

Stomach 

Gastric  Juice 

Rennin 

Pepsin   and  Hy- 
drochloric acid 

Coagulates  milk 

("Acid  Protein, 
«j  Proteoses, 
[Peptones 

Small  Intestine 

Pancreatic  Juice 

Trypsin  (in  alka- 
line medium) 

1" Alkali  Protein, 
-j  Proteoses, 
[Peptones 

Bile 

None 

None 

Intestinal  Juice 

Erepsin  (acts 
only  on  proteo- 
ses   and  pep- 

tOTlOS) 

Amino  Acids 

40 


PRACTICAL  DIETETICS 


DIGESTION  OF  FAT 

Fat  is  not  acted  upon  by  the  secretions  of  the  mouth  nor 
to  any  great  extent  by  those  of  the  stomach.  The  gastric 
juice  contains  an  enzyme,  called  gastric  lipase,  which  has  the 
power  of  acting  on  emulsified  fats,  such  as  in  cream  or  yolk 
of  eggs.  It  plays  a  more  important  part  in  the  digestion  of 
infants  than  of  adults. 

The  presence  of  fat  in  the  stomach  retards  the  secretion  of 
gastric  juice.  Hence  a  certain  excess  of  fat  in  the  stomach 
is  sufficient  to  close  the  pylorus  for  a  longer  or  shorter  time, 
due  to  the  failure  of  the  appearance  of  free  hydrochloric  acid. 
This  doubtless  accounts  for  the  fact  that  fat  in  the  diet  often 
seems  to  retard  and  otherwise  disturb  digestion. 

Digestion  of  fat  takes  place  mainly  in  the  small  intestines. 
The  pancreatic  juice  contains  an  enzyme  called  steapsin,  which 
has  the  power  of  emulsifying  fats  and  also  of  splitting  them 
into  fatty  acids  and  glycerine. 

The  bile  contains  no  such  enzymes,  but  it  is  nevertheless  an 
important  factor  in  the  digestion  of  fat.  It  has  the  power  of 
increasing  greatly  the  activity  of  the  pancreatic  lipase  (steap- 
sin),  and  of  holding  in  solution  the  fatty  acids  formed  by 
its  action,  so  that  they  are  more  perfectly  absorbed.  When 
bile  is  lacking,  much  of  the  fat  fails  of  absorption  and  is 
excreted  through  the  intestines.  Emulsification  is  an  im- 
portant aid  in  the  splitting  of  fat  into  fatty  acids  and  glycer- 
ine, the  forms  in  which  fat  is  chiefly  absorbed. 

DIGESTION  OF  CARBOHYDRATES 

1.  Digestion  of  Starch.  There  is  little  doubt  that  prim- 
itive man  accomplished  much  of  the  digestion  of  starch  in  the 
mouth.  The  saliva  contains  two  enzymes,  ptyalin,  and  maU 
tase.  By  the  action  of  ptyalin  starch  is  changed  to  dextrins 
and  these  to  maltose;  by  the  action  of  maltase,  maltose  is 
converted  into  dextrose,  the  end-product  of  salivary  digestion. 
The  crude  uncooked  food  required  prolonged  mastication  be- 
fore it  could  be  swallowed,  and  during  this  mastication  the 
enzymes  had  opportunity  for  action.    Raw  starch  is  so  very 


DIGESTION 


41 


slowly  affected  by  enzymes,  that  much  of  the  food  value  of  un- 
cooked cereals  is  lost,  so  that  the  practice  of  baking  ground 
grain  into  bread  developed  very  early.  This  fact  in  regard 
to  starch  digestion  is  often  disregarded  by  advocates  of  a  re- 
turn to  raw  foods. 

There  is  said  to  be  some  evidence  that  a  pharyngeal  reflex 
once  existed  which  prevented  the  bolting  of  foods  which  are 
capable  of  salivary  digestion,  or  which  are  not  easily  di- 
gestible without  mastication.  In  recent  years,  Mr.  Horace 
Fletcher  has  counseled  a  return  to  prolonged  mastication,  in 
order  that  salivary  digestion  may  be  carried  to  its  fullest  ex- 
tent. It  is  claimed  that  the  more  perfect  utilization  of  all 
food  eaten  necessitates  the  taking  of  a  smaller  amount. 
There  is  no  doubt  that  thorough  mastication  renders  the  di- 
gestion of  starch  easier  and  more  complete,  but  it  will  not 
greatly  alter  the  total  food  requirement. 

The  starchy  food  mixed  with  saliva  passes  from  the  mouth 
to  the  stomach  and  lodges  in  the  fundus,  the  portions  last 
eaten  always  going  to  the  center  of  the  mass.  Thus,  while 
the  gastric  juice  is  at  work  upon  the  outer  layer,  attacking 
the  protein  of  the  diet,  the  inner  portions  remain  alkaline  for 
a  considerable  time,  so  that  salivary  digestion  may  continue 
undisturbed. 

From  time  to  time,  the  soluble  products  of  salivary  and 
gastric  digestion  pass  into  the  small  intestine.  Here  the  con- 
version of  starch  and  intermediate  products  into  simple  sugars 
is  completed.  The  pancreatic  juice  contains  an  enzyme  called 
amylopsin,  which  acts  like  ptyalin,  i.  e.,  changes  starch  to 
dextrins,  and  finally  to  maltose. 

The  intestinal  juice  contains  an  enzyme  capable  of  chang- 
^  ing  maltose  to  dextrose,  the  final  product  in  starch  digestion. 

Summary.  The  chemical  changes  in  starch  during  the 
process  of  digestion  are  shown  in  the  following  table : 


43 


PRACTICAL  DIETETICS 


PART  OF 
ALIMENTARY 
TRACT 

OF 
NAME 
SECRETION 

ENZYMES 
ACTING  ON 
STARCH 

PRODUCTS  OF 
ENZYME 
ACTION 

Mouth 

Saliva 

Ptyalin 

Maltase 

fDextrins 
\  Maltose 

Dextrose 

Stomach 

Gastric  Juice 

None 

Small  Intestine 

Pancreatic  Juice 

Amylopsin 

fDextrins 
I^Maltose 

Intestinal  Juice 

Maltase 

Dextrose 

2.  Digestion  of  Sugars.  Although  sugars  are  perfectly 
soluble  and  easily  absorbed,  they  must  all  be  converted  into 
monosaccharides  or  simple  sugars  (chiefly  dextrose),  before 
they  can  be  utilized  by  the  body.  Hence  we  find  a  number 
of  enzymes  in  the  alimentary  tract  acting  upon  disaccharides. 
Two  of  these  have  already  been  indicated  in  discussing  the 
digestion  of  starch,  1.  e.,  the  maltases  of  the  saliva  and  in- 
testinal juice,  which  convert  each  molecule  of  maltose  into 
two  of  dextrose.  In  the  stomach,  a  slight  hydrolysis  of  the 
disaccharides  may  occur  through  the  influence  of  the  hydro- 
chloric acid.  In  the  intestines,  provision  is  made  for  their 
complete  transformation.  Both  the  pancreatic  and  intestinal 
juices  contain  enzymes  of  this  type.  In  young  animals,  or 
older  individuals  on  a  milk  diet,  the  pancreatic  juice  con- 
tains lactase,  which  converts  lactose  (milk  sugar)  into  dex- 
trose and  galactose.  The  intestinal  juice  contains  three  such 
enzymes,  sucrase,  acting  on  sucrose  (cane  sugar)  ;  lactase, 
acting  on  lactose ;  and  maltase,  acting  on  maltose. 

Summary.  The  chemical  changes  in  sugar  during  the 
process  of  digestion  are  shown  in  the  following  table : 


DIGESTION 


43 


PART  OF 

NAME 

ENZYMES 

PRODUCTS 

ALIMENTARY 

OF 

ACTING  ON 

OF  ENZYME 

TRACT 

SECRETION 

SUGARS 

ACTION 

Mouth 

Saliva 

Maltase 

Dextrose 

Small  Intestines 

Pancreatic  Juice 

Lactase  (at 
times) 

fDextrose 
\Galactose 

Intestinal  Juice 

Lactase 
Maltase 

Sucrase 

fDextrose 
(^Galactose 

Dextrose 

fDextrose 
I^Levulose 

Mineral  Matter  and  Water  require  no  changes  to  prepare 
them  for  absorption. 

resume'  of  digestion 

The  processes  of  digestion  are  both  mechanical  and  chem- 
ical. By  mechanical  processes  the  foods  are  first  softened 
and  finely  divided,  so  as  to  be  non-irritating  to  the  walls  of 
the  alimentary  tract,  and  to  expose  as  much  surface  as  pos- 
sible to  the  action  of  the  digestive  enzymes;  secondly,  they 
are  moved  along  the  alimentary  tract  from  time  to  time,  to 
facilitate  digestion  and  absorption,  and  to  expel  indigestible 
residues.  The  movements  of  the  mouth  in  mastication,  of 
the  oesophagus  in  swallowing,  and  of  the  intermediate  and 
pyloric  regions  of  the  stomach  in  mixing  the  food  with  the 
gastric  juice;  the  rhythmic  and  peristaltic  movements  of  the 
small  intestines,  by  which  the  food  is  alternately  churned  in 
a  stationary  position  and  then  pushed  along  to  a  new  region 
to  repeat  the  process;  and  finally,  the  anti-peristaltic  move- 
ments of  the  first  part  of  the  large  intestines  and  the  slow 
peristalsis  throughout  its  entire  length,  form  a  series  of  events 
of  tremendous  importance  to  the  welfare  of  the  organism. 

By  chemical  processes^  complex  food-stuffs  are  converted 
into  simpler  substances  out  of  which  the  body  can  build  the 


PRACTICAL  DIETETICS 


compounds  essential  to  its  persistence  and  activity.  The  di- 
gestive fluids  and  the  enzymes  contained  therein,  with  the 
results  of  their  activity,  are  most  readily  indicated  by  the 
following  table: 


PART  OF 
ALIMENTARY 
TRACT 

NAME  OF 
SECRETION 

REACTION 
TO 
LITMUS 

ENZYMES 
PRESENT 

FOODSTUPFS 
ACTED  UPON 

PRODUCTS  OF 
ENZYME 
ACTION 

Mouth 

Saliva 

Alkaline 

Ptyalin 
Maltase 

Starch 
Maltose 

1 

L 

^  Soluble 
Starch- 
Dextrins 
^  Maltose 
>extrose 

Stomach 

Gastric 
Juice 

Acid 

(0.2%- 
0.4% 
H  CI.) 

Pepsin 

Rennin 
Lipase 

Proteins 

Protein 

(especially 

casein  of 

milk) 
Emulsified 

Fats 

] 

c 

F 

^  Acid 

Protein 
Proteoses 
.  Peptones 

oagulated 
Protein 

atty  acids 
and 

glycerine 

Small 

Intestines 

Pancreatic 
Juice 

Alkaline 

Trypsin 
Steapsin 

Amylopsin 

Lactase 
(in  young 
animals) 

Proteins 
Fats 

Starch 

Lactose 
(Milk 
Sugar) 

1 

1 
\ 

r  Alkali 

Protein 
Proteoses 
^  Peptones 
^  Emulsified 

Pat  — 
Fatty 

acids  and 
^  glycerine 
f  Soluble 

Starch  — 
Dextrins  — 
<  Maltose 
'  Dextrose 

and 
.Galactose 

Intestinal 
Juice 

Alkaline 

Erepsin 

Sucrase 

Maltase 
Lactase 

Proteins  in 
the  form  of 
Proteoses 
and 

Peptones 
Sucrose 

Maltose 
Lactose 

Amino 
Acids 

Dextrose  and 
Levulose 

Dextrose 

Dextrose  and 
Galactose 

The  bile  contains  no  important  enzymes,  but  greatly  facilitates  the  diges- 
tion of  fats.  The  intestinal  juice  contains  an  enzyme  which  makes  trypsin 
an  active  enzyme,  and  a  substance  which  helps  to  stimulate  the  flow  of 
pancreatic  juice. 


DIGESTION 


45 


Inspection  of  the  table  on  page  44  shows  that  there  are  five 
so-called  digestive  juices,  viz. :  saliva,  gastric  juice,  pancreatic 
juice,  bile,  and  intestinal  juice.  All  are  produced  intermit- 
tently except  the  bile,  which  is  secreted  continuously  into  the 
gall-bladder  and  discharged  at  intervals  into  the  intestine. 
All  are  alkaline  except  the  gastric  juice.  All  contain  power- 
ful enzymes  except  the  bile.  Enzymes  which  digest  protein 
occur  in  the  gastric  juice  (pepsin),  the  pancreatic  juice  (tryp- 
sin), and  the  intestinal  juice  (erepsin).  Ferments  which 
transform  starch  to  sugar  occur  especially  in  the  saliva  and 
pancreatic  juices,  and  are  commonly  known  as  diastatic 
enzymes.  Ptyalin  is  an  old  name  for  salivary  diastase,  amy- 
lopsin  for  pancreatic  diastase. 

The  principal  fat-splitting  enzyme  occurs  in  the  pan- 
creatic juice,  and  is  known  as  pancreatic  lipase  or  steapsin. 
Numerous  enzymes  of  minor  importance  occur  in  the  gastric, 
pancreatic,  and  intestinal  juices.  Bile  in  itself  is  able  to 
emulsify  fat  as  a  step  toward  digestion. 

FACTORS  DETERMINING  RATE  OF  DIGESTION 

We  know  of  the  existence  of  many  factors  which  influence 
salivary  and  gastric  digestion,  but  much  less  about  intestinal 
digestion.  Among  these  are  the  nature  of  the  food,  cook- 
ery, appetite,  mastication,  palatability,  mental  state,  amount 
of  fluid  in  the  meal,  the  pyloric  reflexes,  etc.  .The  nature  of 
the  individual  plays  a  powerful  role;  some  individuals  can 
subsist  almost  wholly  upon  one  or  a  few  articles,  while  others 
quickly  revolt  against  monotony  of  diet.  Idiosyncrasy  is 
another  important  factor ;  for  example,  some  individuals  can- 
not eat  mutton,  however  disguised,  while  in  others  sugar  is 
so  strong  a  stimulant  to  peristalsis  that  it  sets  up  a  violent 
diarrhoea.  The  above  being  true  of  presumably  healthy  peo- 
ple, the  factors  which  may  influence  digestion  in  the  sick, 
invalid  and  convalescent  must  be  still  more  uncertain. 
Hence  tables  which  purport  to  give  the  relative  digestibility 
of  foods  must  be  studied  with  allowances.  We  can  study  this 
problem  in  test  tubes,  or  by  examining  the  washings  from  the 


46 


PRACTICAL  DIETETICS 


stomach  after  definite  meals  or  in  fistula  patients,  but  the 
results  can  hardly  be  applied  forthwith  to  all  persons. 

The  direct  stimuli  to  the  secretion  of  saliva  are  the  sight, 
odor  or  taste  of  food;  or  the  mechanical  irritation  produced 
by  contact  of  food-stuffs  with  the  mouth.  Indirectly,  the 
thought  of  food  may  be  a  psychic  stimulus  to  the  flow  of 
saliva.  Excitement  may  so  check  the  flow  of  saliva  that  it 
is  impossible  to  swallow  dry  food. 

The  stimuli  to  the  secretion  of  gastric  juice  are  both  psychic 
and  chemical.  Pawlow  has  demonstrated,  in  the  case  of 
dogs,  that  the  sight  of  food  or  the  chewing  of  food  in  the 
mouth  may  produce  a  very  effective  flow  of  gastric  juice,  to 
which  he  attributes  great  importance  in  digestion.  How  im- 
portant this  preliminary  flow  before  food  enters  the  stomach 
may  be  in  the  case  of  man  has  not  been  very  clearly  demon- 
strated, but  it  seems  reasonable  that  the  desire  for  eating,  the 
act  of  eating  and  the  pleasure  obtained  therefrom  exercise 
a  favorable  influence  upon  gastric  secretion.  It  has  recently 
been  shown  that  the  products  of  salivary  digestion  act  as 
a  stimulus  to  the  flow  of  gastric  juice,  and  that  once  the 
process  of  gastric  digestion  is  initiated,  the  products  of  pep- 
tic activity  cause  the  continuance  of  the  secretion  as  long 
as  the  food  remains  in  the  stomach.  The  mere  mechanical 
irritation  caused  by  the  presence  of  food  in  the  stomach  is 
ineffective.  Thus  white  of  egg  will  cause  no  flow.  But  cer- 
tain substances,  such  as  meat  extracts,  bitters  and  condiments, 
promote  secretion.  The  use  of  meat  broths,  gelatin  jellies, 
peptones  (i.  e.,  products  of  gastric  digestion),  and  toast  (con- 
taining dextrins  or  products  of  salivary  digestion),  at  the 
beginning  of  a  meal,  or  to  promote  feeble  gastric  digestion  in 
an  invalid,  is  therefore  a  rational  practice. 

ABSORPTION 

While  absorption  through  a  permeable  animal  membrane 
outside  the  body  may  be  a  simple  physical  process,  following 
the  ordinary  laws  of  pressure,  diffusion,  osmosis,  etc.,  the  case 


ABSORPTION 


47 


is  far  otherwise  in  the  alimentary  tract,  where  the  selective 
activity  of  the  living  cell  becomes  a  positive  factor.  The 
pressure  in  secreting  glands  rises  above  blood  pressure;  sub-  ' 
stances  pass  inward  to  the  body  through  the  mucous  mem- 
brane without  a  corresponding  movement  in  the  opposite  di- 
rection. Thus  blood  serum,  placed  in  a  loop  of  intestine  is 
promptly  absorbed,  but  if  the  loop  be  surrounded  with  serum, 
it  does  not  pass  in  a  similar  manner  into  the  lumen  of  the 
section  of  intestine. 

The  stomach  is  not  primarily  an  absorbing  organ,  but  a  few 
substances,  such  as  sugars  and  peptones,  pass  to  a  limited 
extent  through  its  walls.  The  most  important  seat  of  absorp- 
tion is  the  small  intestine,  and  second,  the  large  intestine. 
Absorption  in  the  small  intestine  is  affected  through  the  in- 
numerable little  projections  with  which  the  intestine  is  lined, 
known  as  villi,  which  greatly  extend  the  amount  of  surface. 
These  villi  contain  a  capillary  network  and  a  so-called  lac- 
teal space.  The  capillaries  by  converging  into  larger  vessels 
eventually  form  the  portal  vein  which  passes  through  the 
liver.  The  lacteal  spaces  are  prolonged  into  lymphatic  ves- 
sels which  similarly  converge  to  form  the  thoracic  duct.  The 
lacteals  are  intended  almost  wholly  for  the  absorption  of  the 
fats,  all  other  digestive  products  passing  through  the  liver 
before  reaching  the  general  circulation. 

Absorption  continues  throughout  the  length  of  the  large 
intestine,  being  especially  favored  by  antiperistalsis  in  the 
upper  portions.  Constipation  sometimes  results  from  the 
great  absorptive  power  of  this  region,  the  feces  being  left  dry 
and  hard  and  hence  difficult  to  evacuate. 

Absorption  of  Protein,  It  was  long  a  matter  of  doubt  as 
to  the  form  in  which  proteins  were  absorbed,  but  there  was  a 
strong  inclination  to  believe  that  they  were  transformed  into 
protein  before  being  transported  by  the  blood,  because  it 
was  almost  impossible  to  detect  amino  acids  in  the  blood  or 
tissues.  We  now  know  that  this  was  due  to  the  imperfection 
of  our  chemical  methods.  It  has  recently  been  demonstrated 
by  several  independent  investigators  that  amino  acids  are 
absorbed  from  the  intestines,  circulate  in  the  blood,  and  pass 


48 


PRACTICAL  DIETETICS 


to  the  tissues,  and  that  the  cells  of  the  body  are  able  to  take 
them  up  and  use  them  according  to  their  needs.  Animals 
have  been  made  to  store  protein  when  the  only  nitrogen 
supplied  to  the  blood  was  in  the  form  of  amino  acids. 

Traces  of  protein,  proteoses  or  peptones,  may  be  absorbed 
from  the  stomach  or  intestines,  but  ordinarily  the  amount  is 
negligible.  Such  products  when  present  in  the  blood  tend 
to  pass  quickly  into  the  urine.  The  peculiar  idiosyncrasy  of 
poisoning  from  such  foods  as  eggs,  milk,  fish,  etc.,  is  thought 
to  be  due  to  the  influence  of  traces  of  absorbed  proteins  to 
which  the  subject  shows  an  anaphylactic  reaction. 

Ahsorption  of  Fat,  It  is  now  commonly  believed  that  fat 
is  absorbed  in  the  form  of  the  end  products  of  its  digestion^ 
i.  e.,  fatty  acids  and  glycerine,  and  that  somewhere  in  the 
intestinal  wall  these  are  recombined  into  neutral  fat.  It  is 
possible  that  some  of  the  finely  emulsified  fat  is  able  to  pass 
unchanged  through  the  intestinal  wall.  In  either  case,  mi- 
nute fat  droplets  pass  into  the  lacteals,  and  finally  into  the 
blood  stream  by  way  of  the  thoracic  duct.  A  small  portion 
finds  its  way  directly  into  the  blood. 

Fats  having  a  low  melting  point  are  absorbed  more  quickly 
than  solid  fats,  and  pure  fat  more  readily  than  fat  inter- 
mingled with  other  food  principles,  as  in  fat  meat. 

Absorption  of  Carbohydrates.  The  end  products  of  carbo- 
hydrate digestion  pass  to  the  blood  by  way  of  the  portal  sys- 
tem. The  monosaccharides  on  reaching  the  liver  enter  the 
general  circulation  as  dextrose  if  required  for  immediate  use ; 
otherwise  they  are  stored  in  the  liver  in  the  form  of  glycogen, 
which  can  be  again  transformed  into  sugar  when  demanded 
by  the  system  to  furnish  energy.  Sugars  are  so  readily  ab- 
sorbed that  if  taken  in  large  quantities  the  body  may  be  un- 
able to  utilize  them,  and  the  excess  is  excreted  in  the  urine. 
This  is  especially  true  in  case  of  an  excess  of  cane  sugar  or 
milk  sugar.  They  may  be  absorbed  before  digestion,  and 
there  are  no  enzymes  in  the  blood  capable  of  converting  them 
into  dextrose  so  that  they  can  be  burned  or  stored.  Under 
such  circumstances  they  are  useless  and  must  be  gotten  rid  of. 
If  maltose  is  absorbed  too  rapidly,  it  may  still  be  changed  to 


ABSORPTION 


49 


dextrose  by  enzymes  in  the  blood  or  tissues^  and  so  be  utilized. 

Absorption  of  Mineral  Matter.  As  salts  are  not  digested 
in  the  ordinary  sense  of  the  word^  they  require  nothing  more 
than  solution  in  the  digestive  fluids  before  absorption.  The 
mineral  matter  is  set  free  frqm  food  and  diffuses  more  or  less 
rapidly  into  the  surrounding  fluids.  Common  salt  is  most 
quickly  absorbed.  The  chief  locality  for  absorption  is  the 
small  intestines.  The  older  text  books  taught  that  salts 
were  absorbed  only  by  diffusion  through  the  intestinal  wall, 
which  required  that  another  solution  must  at  the  same  time 
pass  from  the  blood  to  the  intestines  until  both  fluids  were 
of  the  same  degree  of  concentration.  It  appears,  however, 
that  in  the  main,  mineral  matter  is  taken  up  in  the  intestinal 
wall  without  diffusion,  and  as  fast  as  it  can  be  incorporated 
with  certain  peculiar  solvents  is  absorbed  into  the  blood. 

Absorption  of  Water,  Water  it  not  absorbed  by  the  stom- 
ach, but  passes  quickly  in  little  spurts  (if  taken  alone)  into 
the  intestines.  Here  it  is  very  rapidly  absorbed;  it  may  be 
excreted  through  the  kidneys  within  twenty  minutes  after 
ingestion.  The  rapidity  of  absorption  may  be  considerably 
influenced  by  mineral  matter  dissolved  in  the  water. 

Summary,  Absorption  is  an  active,  not  a  passive  process. 
It  takes  place  mainly  in  the  intestines,  the  larger  part  before 
the  food  reaches  the  ileo-cecal  valve. 

Proteins  are  absorbed  by  the  villi,  chiefly  in  the  form  of 
amino  acids  and  pass  through  the  portal  vein  to  the  liver. 

Fats  are  absorbed  by  the  lacteals,  chiefly  in  the  form  of 
fatty  acids  and  glycerine,  but  pass  to  the  lymphatics  as  neu- 
tral fat,  and  enter  the  blood  stream  from  the  thoracic  duct. 

Carbohydrates  are  absorbed  by  the  villi  in  the  form  of  su- 
gar (chiefly  dextrose)  and  pass  through  the  portal  vein  to 
the  liver. 

Unabsorbed  material  passes  out  as  part  of  the  feces  (see 
Excretion,  page  53).  Undigested  proteins,  fats  and  car- 
bohydrates are  liable  to  attack  by  putrefactive  and  fermenta- 
tive organisms  in  the  intestines.  The  products  of  such  bac- 
terial action  are  absorbed  to  a  considerable  extent.  Carbohy- 
drates which  escape  digestion  tend  to  produce  lactic  and 


50 


PRACTICAL  DIETETICS 


other  acids.  This  fermentation  is  not  altogether  an  evil, 
for  it  checks  the  putrefaction  of  undigested  meat.  The  latter 
is  undesirable^  as  the  products  are  likely  to  prove  toxic.  It 
is  for  this  reason  that  lactic  acid,  especially  in  the  form  of 
buttermilk  and  artificially  fermented  sour  milk,  is  largely 
employed  as  a  remedial  agent  in  intestinal  indigestion. 

METABOLISM 

Metabolism  is  the  sum  of  the  chmical  changes  taking  place 
in  the  cells  of  the  body  in  connection  with  all  biological 
processes,  including  growth,  repair  and  waste,  generation  and 
maintenance  of  heat,  all  manifestations  of  functional  activity, 
storage  of  surplus  nutriment,  etc.  It  comprises  two  phases, 
anabolism  and  katabolism. 

Anabolism  embraces  the  changes  involved  in  the  upbuilding 
of  the  cells,  and  corresponds  in  a  general  way  to  nutrition. 
Assimilation  is  the  selective  act  of  the  cells  in  appropriating 
the  special  form  of  nutriment  in  the  circulating  blood  which 
is  suited  for  their  needs.  The  special  phases  of  anabolism 
comprise  the  assimilation  of  nitrogen  for  growth  and  repair 
of  protoplasm,  the  storage  of  a  certain  amount  of  fat  and 
carbohydrate,  the  assimilation  of  oxygen  for  maintenance  of 
heat  and  functional  activity,  and  the  retention  of  inorganic 
salts  in  the  bones  and  other  tissues. 

Katabolism  comprises  the  changes  involved  in  the  contin- 
uous molecular  waste  of  the  cells;  in  the  constant  oxidation 
going  on  in  the  tissues  resulting  in  the  maintenance  of  animal 
heat;  in  the  exercise  of  muscular,  nervous  and  secretory  ac- 
tivity; and  perhaps  in  the  breaking  up  of  protein  into 
oxidizable  carbohydrates  and  nitrogenous  waste  products. 
We  speak  less  of  the  acts  of  katabolism  than  of  the  products 
of  katabolism,  which  are  a  measure  of  those  acts.  The  chief 
of  these  products  are:  (1)  urea,  the  chief  form  of  excretion  of 
nitrogen,  and  (2)  carbon  dioxide  and  water,  which  represent 
the  products  of  energy-yielding  oxidations. 

Elimination  is  the  escape  or  expulsion  of  the  products  of 


METABOLISM 


51 


katabolism  from  the  tissues  into  the  blood,  and  corresponds 
to  disassimilation  or  denutrition.  Excretion  is  the  final  ex- 
pulsion of  the  end  products  of  katabolism  from  the  excretory 
organs  and  includes  the  expulsion  of  unabsorbed  aliment  by 
the  bowel. 

In  the  case  of  certain  products  of  metabolism,  it  is  hardly 
possible  to  state  positively  whether  they  represent  anabolism 
or  katabolism.  Here  belong  especially  the  substances  formed 
in  connection  with  secretion,  as  the  digestive  enzymes,  the 
hydrochloric  acid  of  the  gastric  juice,  the  iodothyrin  of  the 
thyroid  gland  and  the  adrenalin  of  the  suprarenal  gland.  In 
all  likelihood  both  factors  participate,  for  certain  substances 
must  be  assimilated  from  the  food  to  form  these  bodies  which 
in  turn  are  set  free  in  the  blood.  It  is  also  true  that  some 
of  these  substances  act  by  their  mere  presence,  without  ap- 
parent waste  (catalytic  action). 

Metabolism  of  Protein.  A  relatively  small  proportion  of 
protein  is  normally  disposed  of  by  oxidation  for  energy-forma- 
tion, when  carbohydrates  and  fats  enter  fully  into  the  diet. 
But  in  their  absence,  protein,  by  virtue  of  the  fact  that  it  con- 
tains the  elements  of  carbohydrates  and  fats  (carbon,  hydro- 
gen and  oxygen)  in  its  molecule,  can  furnish  all  the  heat  and 
force  required.  Certain  savages  subsist  wholly  on  meat  and 
remain  in  good  health,  and  in  the  so-called  Salisbury  treat- 
ment of  obesity,  etc.,  it  can  be  demonstrated  at  will  that  a 
patient  may  subsist  for  weeks  on  raw  beef  without  apparent 
detriment,  provided  plenty  of  water  is  drunk,  the  excess  of 
water  aiding  in  the  elimination  of  unutilized  nitrogen. 

When  absorbed  protein  reaches  the  liver,  a  large  part  of  the 
nitrogen  is  split  off  and  excreted  as  urea.  The  remaining 
portion  goes  to  make  good  the  small  daily  waste  of  body 
protein.  The  portion  of  the  protein  molecule  left  after  the 
nitrogen  is  split  off  is  available  as  fuel.  When  carbohydrates 
and  fats  are  liberally  supplied,  so  that  protein  is  not  required 
for  fuel,  the  daily  amount  needed  is  comparatively  small. 
Even  when  the  body  is  losing  nitrogen  rapidly,  as  in  certain 
fevers^  it  has  been  found  that  this  is  partly  because  the  body 


52 


PRACTICAL  DIETETICS 


protein  is  being  nsed  as  fuel,  and  the  loss  can  be  largely 
prevented  by  furnishing  more  energy  in  the  form  of  carbo- 
hydrate or  fat.  Much  confusion  has  arisen  because  the  excess 
of  nitrogen  in  the  diet  is  to  some  extent  identical  in  form 
with  the  waste  products  of  cellular  activity.  Besides  urea, 
some  of  the  chief  nitrogenous  products  of  protein  metabolism 
are  ammonium  salts,  uric  acid,  creatin  and  creatinin. 

The  non-nitrogenous  portion  of  protein  may  be  burned  or 
possibly  stored,  but  the  nitrogen  excess  must  be  eliminated. 
Because  of  the  fact  that  excess  of  nitrogen  throws  work  on  the 
kidneys,  it  is  assumed  that  an  excessive  protein  diet  is  injuri- 
ous to  the  integrity  of  these  organs.  This  is  evident  in  dis- 
eased kidneys,  but  cannot  be  proved  for  healthy  organs. 
However,  it  seems  unnecessary  to  consume  a  great  excess  of 
protein  and  perhaps  unwise,  owing  to  the  great  frequency  of 
fatal  kidney  diseases.  At  any  rate,  except  where  protein  is 
specially  advantageous  for  ease  of  digestion,  it  is  unnecessary 
to  make  it  a  large  part  of  the  diet. 

Metabolism  of  Fat.  Fat,  which  is  passed  into  the  blood 
from  the  thoracic  duct,  is  carried  over  the  body  and  deposited 
in  many  organs  and  tissues,  unless  needed  for  immediate  use 
as  a  source  of  energy,  in  which  case  it  is  oxidized  to  carbon 
•dioxide  and  water.  It  has  been  shown  that  diet-fat  may  be 
deposited  in  the  body  in  the  same  form  as  eaten,  but  the 
readiest  means  of  forming  body  fat  is  usually  to  give  an 
excess  of  carbohydrate.  The  ease  with  which  carbohydrates 
form  fat  is  shown  in  the  case  of  cows  which  produce  large 
quantities  of  butter  fat  on  an  herbivorous  diet.  It  is  also 
possible  to  form  fat  from  protein,  but  it  is  difficult,  as  a  con- 
siderable part  of  the  energy  of  the  protein  molecule  goes  to 
get  rid  of  the  nitrogen,  and  protein  increases  the  rate  of  metab- 
olism. We  know  very  little  of  the  details  of  fat  metabolism. 
Some  investigators  hold  that  it  must  be  converted  into  dex- 
trose before  it  can  be  oxidized.  As  already  stated,  an  excess 
of  carbohydrate  may  be  stored  in  the  form  of  fat. 

Metabolism  of  Carbohydrates,  The  blood  maintains  a  con- 
stant sugar  content  of  about  0.8  per  cent.    As  fast  as  this 


EXCRETION 


53 


sugar  is  oxidized,  it  is  replaced  by  more  from  the  store  of 
glycogen  in  the  liver  and  muscles,  or  from  newly-formed 
sugar  of  recently  digested  food.  The  final  products  of  carbo- 
hydrate oxidation  are  carbon  dioxide  and  water,  but  several 
intermediate  products  (as  lactic  acid)  are  first  formed,  prob- 
ably by  the  action  of  enzymes. 

When  the  body  is  unable  to  store  any  more  carbohydrate  as 
glycogen,  all  further  storage  of  excess  is  in  the  form  of  fat. 

When  sugar  is  lacking  in  the  blood,  as  in  starvation  or 
failure  to  utilize  carbohydrates,  the  sugar  content  is  main- 
tained at  the  expense  of  protein.  This  explains  why  the  dia- 
betic who  is  eating  no  carbohydrate,  may  still  excrete  sugar 
in  the  urine.  There  is  some  experimental  evidence  that  su- 
gar may  be  formed  also  from  fat.  At  any  rate,  fat  is  oxidized 
in  absence  of  carbohydrate,  and  whether  it  is  first  changed  to 
sugar,  or  oxidized  directly,  it  is  a  compact  means  of  storing 
energy,  since  one  gram  of  fat  will  yield  2l^  times  as  much 
as  an  equal  amount  of  protein  or  carbohydrate. 

EXCRETION 

The  waste  products  of  metabolism  and  all  unutilized  food, 
along  with  the  products  of  oxidation,  are  eliminated  from  the 
system  in  several  ways.  Water  escapes  through  the  lungs, 
skin  and  kidneys.  Aside  from  the  obvious  fluid  perspiration, 
a  steady  evaporation  takes  place  from  the  skin  (insensible 
perspiration).  The  carbon  dioxide  produced  by  oxidation 
escapes  by  the  lungs,  and  nitrogenous  products  of  protein  me- 
tabolism by  the  urine.  The  feces  in  health  are  made  up 
of  the  secretions  and  excretions  of  the  alimentary  tract,  bac- 
teria, indigestible  food  waste,  and  a  little  undigested  food 
material.  When  there  is  excessive  putrefaction  of  the  fecal 
matter,  some  of  the  soluble  material  is  absorbed  and  elimi- 
nated in  the  urine.  Generally  speaking,  putrefaction  (of 
nitrogenous  food)  and  fermentation  (of  carbohydrates)  hold 
each  other  in  check.  Starving  people  pass  feces,  thus  show- 
ing that  the  bowel  is  a  true  excretory  organ. 


CHAPTER  III 


FOOD  VALUES 
NITROGEN  BALANCE  — ENERGY  VALUE  OF  FOOD 

We  are  now  in  position  to  understand  something  of  food 
values,  which  depend  on  the  food  actually  utilized  in  the  body, 
to  the  exclusion  of  food  unabsorbed,  or  eliminated  because  in 
excess  of  the  demands  of  the  system.  Energy-yielding  ma- 
terial which  is  not  used  at  the  time  may  be  stored,  but  be- 
yond a  certain  point,  stored  nutriment  must  be  regarded  as 
undesirable,  as  in  obese  subjects. 

As  stated  by  Atwater,  the  food  supplies  body  wants  in  five 
ways:  (1)  tissue-building,  (2)  tissue-repairing,  (3)  storage 
for  future  use,  (4)  oxidation  to  maintain  animal  heat  and  (5) 
oxidation  to  supply  energy;  or  we  may  say  that  according  to 
function,  foods  are  classified  as  tissue-formers,  or  body-build- 
ers; energy  (or  work  and  heat)  producers;  and  regulators  of 
body  processes.    (See  page  5.) 

NITROGEN  BALANCE  OR  NITROGEN  EaUILIBRIUM 

In  body  building  and  repairing,  the  nitrogen  of  protein 
food  is  indispensable.  In  the  other  functions,  nitrogen  is  not 
utilized.  Carbohydrates  and  fats  are  the  natural  and  con- 
venient sources  of  energy,  although  the  protein  contains  in 
itself  non-nitrogenous  material  capable  of  oxidation.  As  al- 
ready stated,  however,  to  depend  largely  upon  protein  for 
oxidizable  food  means  the  ingestion  of  an  enormous  quantity 
of  unnecessary  nitrogen,  the  getting  rid  of  which  involves 
waste  of  energy  and  is  thought  to  necessitate  a  strain  upon 
the  excretory  system.  Furthermore,  when  the  diet  consists 
chiefly  of  protein,  much  of  the  latter  may  not  be  digested  and 
absorbed  as  such,  but  may  remain  in  the  intestine,  there  to 

54 


NITROGEN  BALANCE 


55 


undergo  putrefactive  changes.  In  the  course  of  putrefaction 
certain  soluble  poisonous  substances  form  and  are  absorbed, 
requiring  elimination  by  the  kidneys.  The  excess  of  nitrogen 
which  cannot  be  utilized  in  tissue  repair  must  also  be  elimi- 
nated by  the  kidneys.  Thus  while  people  may  thrive  on  a 
diet  rich  in  protein,  there  is  considerable  evidence  that  vital- 
ity, endurance  and  resistance  to  disease  are  better  attained 
with,  a  diet  in  which  the  fuel  foods  (carbohydrates  and  fats) 
predominate. 

jSTitrogen  cannot  be  stored  to  any  extent  and  is  constantly 
eliminated  in  the  urine  as  urea  and  other  nitrogenous  sub- 
stances. When  the  diet-nitrogen  corresponds  in  amount  with 
the  eliminated  nitrogen,  the  metabolism  of  nitrogen  is  bal- 
anced, or  in  a  state  of  equilibrium.  If  too  small  a  quantity 
of  nitrogenous  food  is  taken  it  does  not  compensate  for  the 
waste  of  body  nitrogen  which  is  inseparable  from  life.  The 
same  thing  occurs  when  for  any  reason  the  food  nitrogen  is 
not  absorbed,  or  is  eliminated  without  being  utilized.  This 
condition  of  nitrogen  starvation  is  characteristic  of  under- 
feeding, wasting  diseases,  defective  assimilation,  etc.  Con- 
versely equilibrium  between  food  nitrogen  and  excreted  ni- 
trogen represents  good  nutrition,  health  and  energy ;  for  while 
nitrogen  cannot  be  permanently  stored,  it  is  possible  for  a 
balance  to  be  maintained  over  long  periods.  It  was  once 
taught  that  increased  elimination  of  nitrogen  was  due  chiefly 
to  the  waste  of  tissue  incidental  to  prolonged  and  severe 
muscular  or  nervous  effort;  at  a  later  period,  however,  it  be- 
came apparent  that  this  waste  was  comparatively  little,  and 
constant  for  the  individual  regardless  of  the  amount  of  muscu- 
lar exercise,  so  that  the  urea  nitrogen  depends  chiefly  on  the 
amount  of  diet  nitrogen.  The  loss  of  nitrogen  in  wasting 
disease,  starvation,  etc.,  is,  however,  extensive ;  so  that  in  con- 
valescence the  body  is  able  to  store  some  nitrogen. 

Nitrogen  retention  is  greatly  facilitated  in  all  cases  by  a 
liberal  supply  of  carbohydrates  and  fats. 

Nitrogen  metabolism  can  hardly  be  studied  in  the  ordinary 
patient^  on  account  of  the  number  and  variety  of  tests  which 


56 


PRACTICAL  DIETETICS 


must  be  accurately  made,  so  that  our  only  guide  is  the  results 
of  scientific  investigation  of  the  amounts  of  nitrogen  required 
under  given  conditions,  and  the  general  well-being  of  the 
subject.  If  weight  is  maintained,  along  with  a  healthy  state 
of  functions,  the  ration  in  question  is  suitable  for  the  sub- 
ject tested.  If  the  individual  be  in  the  growing  period,  the 
ration  should  be  such  that  the  growth  rate  is  normal.  If 
he  be  a  convalescent,  the  recovery  of  the  original  weight  should 
be  constantly  progressive.  .  Of  late  years,  however,  the  em- 
phasis on  nitrogen  values  alone  has  been  largly  superseded 
by  greater  attention  to  total  fuel  values  as  being  of  greater 
practical  worth.  It  is  known  that  a  relatively  small  and 
easily  obtained  quantity  of  nitrogen  is  sufficient  to  repair  waste 
in  the  average  individual,  but  the  food  required  for  producing 
energy  is  very  significant  in  amount.  With  a  liberal  supply 
of  carbohydrates  and  fats,  the  ordinary  daily  waste  of  nitrogen 
in  one  adult  may  be  reduced  as  low  as  3  to  4  grams  daily 
(corresponding  to  20  to  25  grams  of  protein). 

To  insure  a  full  supply  of  nitrogen,  and  to  maintain  ni- 
trogen equilibrium  at  a  higher  level  than  the  bare  maintenance 
requirement,  considerably  more  than  this  amount  is  commonly 
taken.  From  80  to  100  grams  of  protein  per  day  is  re- 
garded as  a  liberal  supply  for  an  average  man  (weighing  70 
kilograms  or  154  lbs.)  on  an  ordinary  mixed  diet  of  suitable 
energy  valuCo 

THE  ENERGY  VALITE  OF  FOOD 

In  Liebig's  time  it  was  recognized  that  animal  heat  was 
generated  by  carbohydrates  and  fats,  but  the  physiologists  of 
that  day  did  not  realize  that  these  were  the  nutrients  which 
furnished  the  body  with  energy  for  its  activity.  They 
thought  that  all  muscular  work  was  done  at  the  expense  of 
nitrogenous  material.  It  has  taken  many  years  for  us  to 
realize  fully  that  animal  energy  in  all  its  forms  is  derived 
primarily  from  carbohydrate  material,  secondly  from  fats,  and 
thirdly  from  proteins  only  in  so  far  as  they  yield  combustible, 
Bon-nitrogenous  bodies. 


ENERGY  VALUE 


57 


Energy  may  be  defined  as  the  power  to  do  work.  This 
force  manifests  itself  in  different  ways.  It  may  be  latent^ 
or  inactive;  or  it  may  be  active  in  various  forms,  such  as 
heat ;  chemical  or  electrical  energy ;  or  mechanical  movement^ 
which  we  call  work.  It  may  be  changed  from  one  of  these 
forms  into  another  without  loss.  The  most  convenient  way  to 
measure  energy  is  by  transforming  it  into  heat.  A  unit  has 
been  devised  to  express  different  amounts  of  heat,  correspond- 
ing to  a  definite  number  of  work  units ;  this  is  called  the 
calorie.  One  calorie  represents  the  amount  of  heat  required 
to  raise  the  temperature  of  one  kilogram  of  water  one  degree 
Centigrade.  This  is  called  the  large  calorie,  which  is  com- 
monly used  in  determining  the  energy  value  of  food.  The 
small  calorie  is  tAtt  of  a  large  calorie. 

Energy  cannot  be  created.  We  must  put  into  any  machine 
as  much  force  as  we  expect  to  get  from  it.  Even  in  the  most 
efficient  machine  we  cannot  recover  all  of  the  energy  in  the 
form  of  useful  work;  some  of  it  is  always  transformed  into 
heat,  owing  to  friction.  This  is  true  even  in  the  body,  which 
is  a  most  efficient  machine,  but  here  much  of  the  waste  energy 
in  the  form  of  heat  is  turned  to  good  account  in  maintaining 
the  body  temperature. 

The  source  of  energy  for  the  body  is  food,  just  as  much  as 
the  source  of  energy  for  the  engine  is  coal.  Plants  store  up 
the  sun^s  energy,  it  is  transferred  to  animals  which  eat  the 
plants,  and  eventually  man  gets  it  by  eating  the  plant  and 
animal  foods.  The  amount  of  energy  in  any  given  food  ma- 
terial is  measured  by  the  amount  of  heat  which  it  will  pro- 
duce. In  general,  this  is  the  same,  whether  the  food  be 
burned  outside  or  inside  the  body,  the  total  result  in  any  case 
depending  upon  the  amount  of  the  food-stuff  which  is  utilized 
by  the  body. 

An  instrument  devised  for  the  measurement  of  heat  is 
called  a  calorimeter.  To  determine  the  fuel  value  of  any 
food  material  outside  of  the  body,  a  given  amount  is  placed 
in  a  calorimeter,  where  it  is  burned  in  an  atmosphere  of  pure 
oxygen,  in  a  vessel  surrounded  by  water.    The  heat  generated 


58 


PRACTICAL  DIETETICS 


raises  the  temperature  of  the  water,  and  the  change  is  ob- 
served with  a  very  delicate  thermometer.  From  this  the 
total  heat  evolved  is  calculated.  To  determine  the  fuel  value 
of  this  material  within  the  body,  the  average  amount  which 
is  lost  in  digestion,  or  which  is  not  completely  oxidized  before 
excretion,  is  deducted  from  the  fuel  value  outside  the  body. 
The  result  is  the  physiological  fuel  value.  Many  years  ago, 
Eubner  determined  averages  for  proteins,  fats,  and  carbohy- 
drates from  experiments  on  dogs.  In  recent  times,  further 
experiments  made  in  this  country  on  human  subjects  by  Prof. 
Atwater  and  his  associates  have  modified  these  factors  some- 
what. The  following  are  therefore  accepted  as  the  average 
energy  values  of  food  in  the  body  to-day : 

1  gram  of  Protein   yields  4  Calories 

1  gram  of  Fat    yields  9  Calories 

1  gram  of  Carbohydrate  .  . .  yields  4  Calories 

DETERMINATION  OF  ENERGY  VALTJE  OF  FOOD 

To  determine  the  energy  value  of  a  given  amount  of  any 
food,  it  is  necessary  to  know  first  its  composition,  i.  e.,  the 
percentages  of  protein,  fat,  and  carbohydrate  present.  Tables 
are  available  giving  the  results  of  many  analyses,  as  in  Bulle- 
tin 38,  Office  of  Experiment  Station,  United  States  Dept.  of 
Agriculture,  Washington,  D.  C,  The  Chemical  Composi- 
tion of  American  Food  Materials.^^ 

Second.  From  these  percentages  to  determine  the  weight 
of  protein  fat  and  carbohydrate  in  grams,  which  can  be  ob- 
tained from  a  given  amount  of  the  food  material. 

Third.  To  multiply  these  weights  by  the  energy  value  of 
one  gram  of  each  of  the  three  food  principles. 

By  way  of  illustration  let  us  find  the  fuel  value  of  one  loaf 
of  bread,  weighing  12  ounces. 

(1)  By  referring  to  Bulletin  28,  we  find  that  white  bread 
(miscellaneous)  yields  on  the  average, 

9.3  %  protein. 
1.2  %  fat. 
52.7  %  carbohydrate. 


ENERGY  VALUE 


59 


(2)  To  get  the  weight  of  protein,  fat  and  carbohydrate  in 
grams,  we  must  first  convert  the  total  weight  of  bread  into 
grams, 

1  oz.         28.35  grams. 
12  oz.  =  340.2  grams. 
Then  340.2  X  0.093  =    31.64  grams  of  protein. 
340.2  X  0.012  =     4.08  grams  of  fat. 
340.2  X  0.527  —  179.28  grams  of  carbohydrate. 

(3)  Multiplying  the  amount  of  each  nutrient  by  the  proper 
factor, 

31.64  grams  protein  X  4  =  126.56  Calories 

4.08  grams  fat  X  9  =  36.72  Calories 

179.28  grams  carbohydrate  X  4  =  717.12  Calories 

Total  880.40  Calories 

Hence  the  total  energy  value  of  1  loaf  of  bread  weighing  12 
ounces  is  880.4  calories. 

To  calculate  the  total  energy  value  of  any  combination  of 
foods,  it  is  necessary  to  compute  the  fuel  value  of  each  in- 
gredient, and  take  the  sum  of  the  whole  group. 

Thus  for  Egg  Broth,  page  118,  it  is  necessary  first  to  get 
the  weight  in  grams  of  each  of  the  following  ingredients  and 
then  to  estimate  their  energy  value  as  indicated  above. 

Yolk  of  1  egg  =  13  grams. 

1  tablespoon  sugar  =  15  grams. 

1  cup  milk  =  244  grams. 

1  tablespoon  brandy  =  14  grams. 

In  this  book  the  food  values  of  all  the  materials  used  have 
been  incorporated  into  a  table,  so  that  by  reference  to  this 
the  value  of  any  combination  is  quickly  made. 

Yolk  of  1  egg  =  48  Calories. 

1  tablespoon  sugar  =:  60  Calories. 

1  cup  milk  =  169  Calories. 

1  tablespoon  brandy  i  =  42  Calories. 

Total  energy  value  319  Calories. 

^The  energy  value  of  alcohol  is  7  calories  per  gram.  It  is  necessary, 
therefore,  to  know  the  per  cent,  of  alcohol  in  any  liquor. 


60 


PRACTICAL  DIETETICS 


To  estimate  the  fuel  value  of  any  diet,  it  is  simply  necessary 
to  compute  the  food  value  of  each  food  material  used  and  add 
the  results  together. 

To  estimate  the  fuel  value  of  an  infant's  diet,  the  following 
formula,  adapted  to  the  above  factors  for  energy  value  from 
Friedenwald  and  Euhrah's  Diet  in  Health  and  Disease,  is 
very  convenient. 

Formula  for  calculating  the  Calories  of  Any  Period  of 
Infant  Feeding: 

( 1 )  Quantity  X  F  X  2.65  =  Calories  from  fat. 

(2)  Quantity  X  (S  +  P)  X  1.18  =  Calories  from  protein  and  sugar. 

The  sum  of  1  and  2  gives  the  total  calories. 

Quantity  =  24-hour  amount  in  ounces.  F,  S  and  P  = 
fat,  sugar^  and  protein  respectively,  with  percents  in  whole 
numbers. 

To  illustrate,  take  a  formula  of  the  following  composition : 

Protein    0.7% 

Fat   2.7% 

Carbohydrates    6.0% 

Feedings  per  day  9,  amount  at  each  finding  1%  oz. 

Hence  Q=  13.5  oz.  (9  X  1%) 
F—  2.7  oz. 
8=  6  oz. 
P=  0.7  oz. 

(1)  Q.  X  F  X  2.65  =  13.5  X  2.7  X  2.65  =  96.6  Cal. 

(2)  Q.  X  (S  +  P)  X  1.18  =  13.5  X  (6  +  0.7)  X  1.18  =  106.7  Cal. 

96.6  +  106.7  =  203.3  Cal.,  total  for  day. 

THE  ENERGY  REQUIREMENTS  OF  THE  BODY 

Work  goes  on  continually  in  the  living  body,  whether  asleep 
or  awake,  idle  or  active,  sick  or  well.  Iii  the  resting  body  it 
consists  of  such  internal  work  as  that  of  digestion  and  absorp- 
tion, circulation,  respiration,  muscular  tension,  and  intracellu- 
lar work. 

In  youth  these  functions  are  more  active  than  in  adult  life  ; 
in  old  age  they  are  somewhat  less  active. 


ENERGY  REQUIREMENT  61 


For  a  man  of  average  weight  (154  lbs.  or  70  kg.)  from 
1600  to  2000  cal.  daily  are  required  to  supply  energy  for 
these  internal  activities.  Children  require  somewhat  more  in 
proportion  to  their  body  weight,  aged  persons  somewhat  less. 
Beyond  this,  the  factor  of  most  significance  in  determining  the 
total  food  requirement  for  any  individual  is  the  amount  of 
muscular  activity.  A  man  requiring  100  cal.  per  hour  at 
rest  may  by  hard  work  raise  his  energy  requirement  as  high 
as  500  or  600  cal.  per  hour.  For  this  reason  a  person  en- 
gaged in  a  sedentary  occupation  needs  less  food  than  one 
whose  work  is  physical,  as  a  farmer  or  lumberman.  Children 
are  usually  more  active  than  adults,  and  hence  in  proportion 
to  their  weight  require  more  food,  while  inactive  aged  per- 
sons require  very  little. 

Averages  obtained  from  many  observations  on  the  amount 
of  food  consumed  by  individuals  under  different  conditions, 
show  that  the  energy  requirement  of  the  active  man  of  70 
kgs.  body  weight  is  approximately  3000  calories. 

In  making  estimates  for  any  individual,  age,  weight,  size 
and  shape,  season  and  climate,  mechanical  efficiency,  etc., 
must  be  considered  as  well  as  muscular  activity. 

During  the  early  months  of  life,  children  require  about  100 
cal.  per  kilogram  of  body  weight.  Throughout  the  years  of 
childhood,  they  need  about  80  calories  per  kilogram.  The 
adult  moderately  active,  35-40  cal.  per  kilogram,  and  the 
very  aged,  about  27  cal.  per  kilogram. 

"  The  following  table,  computed  by  Eubner,  shows  the  daily 
heat  consumption,  in  units  of  heat  (calories)  in  an  adult, 
weighing  65  kilograms  or  140  lbs.'' 

During  rest  in  bed. .  1800  calories  or  28  Cal.  per  kilogram. 

In  repose    2100  calories  or  32  Cal.  per  kilogram. 

In  light  work   2300  calories  or  33  Cal.  per  kilogram. 

In  moderate  work..  2600  calories  or  40  Cal.  per  kilogram. 

In  hard  work   3100  calories  or  48  Cal.  per  kilogram. 

The  total  energy  requirement  for  individuals  under  differ- 
ent conditions  of  age,  weight,  and  activity  are  approximately 
as  indicated  in  the  following  table: 


62 


PRACTICAL  DIETETICS 


ENERGY  PER  T)AY\ 
CONDITIONS  IN  CALORIES 

Man  at  light  work     2500-2800  Cal. 

Man  at  moderate  work    3000-3500  Cal. 

Man  at  very  hard  work    4000-5000  Cal. 

Woman  at  light  work   1800-2400  Cal. 

Woman  at  moderate  work   2400-2800  Cal. 

Child  from  two  to  six   1200-1800  Cal. 

Child  from  six  to  fifteen   1800-2500  Cal. 

Aged  Man    1800-2000  Cal. 

Aged  Woman   "   1600-1800  Cal. 

The  most  convenient  means  of  calculating  the  energy  value 
is  afforded  by  the  following  table,  determined  for  the  adult 
man  of  average  weight. 

AVERAGE  NORMAL  OUTPUT  OP  HEAT  FROM  THE  BODY 

AVERAGE 

CONDITIONS  OF  MUSCULAR  ACTIVITY  CALORIES  PER 

HOUR 

Man  at  rest,  sleeping   65  Calories 

Man  at  rest,  awake,  sitting  up    100  Calories 

Man  at  light  muscular  exercise    170  Calories 

Man  at  moderately  active  muscular  exercise  .  .  290  Calories 

Man  at  severe  muscular  exercise    450  Calories 

Man  at  very  severe  muscular  exercise   600  Calories 

To  illustrate  the  use  of  this  table,  let  us  calculate  the 
energy  requirement  of  a  woman  weighing  120  lbs.,  under 
the  following  conditions : 

Sleeps  9  hours    9  X   65  =  585  Cal. 

Works  at  desk  8  hours    8  X  100  =  800  Cal. 

Walks  or  does  light  exercise  3  hrs  3  X  170  =  510  Cal. 

Reads  or  sits  quietly  sewing  4  hrs  4  X  100  =  400  Cal. 

2295  Cal. 

Since  these  factors  are  for  a  man  weighing  154  lbs.,  for  a 
woman  of  120  lbs.  under  above  conditions,  reduce  this  pro- 
portionately to  her  weight, 

154  :  120  :  :  2295  :  X 

X=   1788  cal. —  total   energy  requirement  for 
a  woman  of  120  lbs.,  under  the  above  conditions. 


ENERGY  REQUIREMENT 


63 


The  protein  requirement  is  conveniently  estimated  by  pro- 
viding 10-12  per  cent,  of  the  day's  energy  in  the  form  of 
protein.  Thus  for  a  man  whose  energy  requirement  is  3000 
cal.  per  day,  360  cal.  from  protein  (13  per  cent.)  would 
correspond  to  90  grams  of  protein,  which  would  be  a  fairly 
liberal  allowance. 

A  tall  thin  person  requires  more  food  than  a  short  fat 
person  of  equal  weight.  Also,  the  person  of  nervous  tem- 
permanent,  in  whom  muscular  tension  is  high,  may  require 
more  food  than  one  of  phlegmatic  temperament.  More  en- 
ergy is  lost  in  the  form  of  heat  in  cold  weather  than  in  warm. 
Because  of  the  numerous  factors  involved  in  any  case,  it  is 
possible  to  calculate  the  absolute  energy  requirement  only 
by  rigid  scientific  experiment.  The  tables  given  above,  how- 
ever, are  a  useful  guide  to  the  approximate  amount  of  food 
required  by  different  individuals. 

As  an  aid  to  easy  estimation  of  the  food  value  of  any  diet, 
the  following  tables  have  been  introduced,  showing  the  nutri- 
tive value  of  the  food  materials  used  in  the  recipes  in  this 
book,  calculated  for  the  quantities  commonly  required  in 
cooking  for  individuals. 

The  values  for  larger  amounts  will  be  easily  obtained  by 
simple  multiplication. 


64 


PRACTICAL  DIETETICS 


TABLE  SHOWING  THE  NUTRITIVE  VALUE  OF  THE  FOOD  MA- 
TERIALS USED  IN  THE  RECIPES  IN  THIS  BOOK,  CALCU- 
LATED FOR  THE  QUANTITIES  COMMONLY  REQUIRED  IN 
COOKING  SMALL  PORTIONS 


FOOD  MATERIAL 
(Uncooked) 

Measure 

\  1 

i 

-  Weight 

Protein 

Fat 

Carbo- 
hydrates 

Fuel  Value 

Calor- 

A 

Ozs, 

Gms, 

Gms. 

Gms. 

Gms. 

ies 

Almonds,  Shelled  

1  cup 

5.6 

160 

33.6 

87.8 

27.7 

1035 

Apples,  Fresh  

Dried  

1  medium 

5+ 

150 

0.5 

0.5 

16 

70 

Icup 

00 

1  A 

1  9 
1 . 0 

00.  z 

247 

Apricots,  Dried  

1  cup 

5 

142 

6.6 

1.4 

88.5 

354 

1  tbsp. 

V2 

14+ 

13.8 

55 

1  bunch 

44(2^ 

1247 

22.4 

2.4 

41.0 

276 

lbs.) 

B 

Bacon  

1  serving 

0.6 

18 

1.6 

10.4 

100 

1  lb. 

16 

454 

43 

269.4 

2597 

Bananas  

1  medium 

100 

0.8 

0.4 

14.0 

64 

"  Crushed  

1  tbsp. 

27 

2.2 

0.3 

19.8 

90 

1  tbsp. 

14-1- 

11 

0  1 

11^3 

51 

Flour...  

1  tbsp. 

16 

l!3 

o!2 

12.5 

57 

1  cup 

8 

227 

19.0 

2.5 

174.3 

796 

1  serving 

3^ 

100 

18.6 

2.8 

100 

lib. 

16 

454 

84.3 

12.6 

452 

1  tbsp. 

8 

1.8 

0.1 

4.8 

28 

«(  « 

1  cup 

42/5 

125 

29.3 

2.3 

77.5 

448 

1  serving 

4 

113 

2.4 

0.3 

5.8 

44 

Beef  Broth 

1  serving 

100 

1.8 

1.02 

16". 5 

1  quart 

32 

907 

16.5 

9.3 

149. 

1  serving 

100 

4.9 

0.6 

25 

u  u 

1  tbsp. 

¥2 

14.1 

.31 

13.1 

120 

1  lb. 

16 

454 

9.92 

420.8 

3828 

Beef  Steak,  Porterhouse  

u           a  u 

1  serving 

100 

19.1 

18.0 

238 

1  IS. 

16 

454 

86.6 

Sir. 2 

1077 

u           a  u 

1  serving 

3H 

100 

21.0 

13.7 

207 

lib. 

16 

454 

94.8 

62.1 

938 

"        "  Sirloin  

1  serving 

33^ 

100 

16.5 

16.1 

211 

lib. 

16 

454 

74.8 

73.0 

957 

«     Top  of  Round  

1  serving 

W2 

100 

19.5 

7.3 

144 

1  lb.  ^ 

16 

454 

88.45 

33.1 

652 

ESTIMATES  OF 


FOOD  VALVES 


65 


FOOD  MATERIAL 

(Uncooked) 

Measure 

Weight 

Protein 

Fat 

Carbo- 
hydrates 

Fuel  Value 

Calor- 

B— (Continued) 

Ozs. 

Gms, 

Gms. 

Gms. 

Gms. 

ies 

Blue  Fish,  (edible  portion)  

1  serving 

100 

19.4 

1.2 

88 

1  lb. 

16 

454 

87.8 

5.44 

401 

1  tbsp. 

M 

14+ 

42 

1  cup 

2^ 

71 

7.8 

1.5 

43.4 

218 

Brazil  Nnts,  Shelled  

lib. 

16 

454 

76.94 

302.88 

31.68 

3048 

an  u 

1  nut 

M 

1.20 

4.74 

0.05 

47.6 

urn  u 

1  tbsp. 

chopped 

M 

3  6 

14.22 

0.15 

142.8 

Bread,  White  

1  slice 

1 

28.4 

2.6 

0  3 

15  0 

73 

1  loaf 

12 

340 

31.6 

4.1 

179.3 

881 

**      Crumbs  (dry)  

1  cup 

136 

12.6 

1.6 

71.7 

352 

1  small 

u                u  a 

slice 

1 

28.4 

1.5 

0.5 

13.3 

64 

1  slice 

1 

28.4 

8.4 

.30 

8.5 

70.3 

1  loaf 

13 

386.5 

114 

4. 

116.3 

957.2 

Butter  

1  tbsp. 

14+ 

0.1 

12.1 

109 

cup 

g 

227 

2.2 

193 

1744 

C 

1  small 

2.0 

57 

0.5 

4.2 

20 

1  serving 

4.0 

113 

2.0 

0.6 

5.2 

35 

Celery  

1  serving 

2.0 

57 

1.4 

6 

Cheese,  American  

1  tbsp. 

15 

4.0 

5.0 

62 

**              *       (fresh  grated). . 

2  tbsp. 

1 

28  4 

8.0 

10  0 

124 

*  Cottage  

1  serving 

1 

28' 

5.9 

0^28 

'l.2 

31 

2  tbsp. 

8 

23 

6.1 

8.1 

0.5 

100 

(1J4  cubic 

inch) 

   A*  \ 

1  serving 

100 

21.4 

2.5 

108 

1  IK 
1  ID. 

10 

454 

y/  .0 

11 .3 

492 

Chocolate,  (unsweetened)  

1  square 

1 

28.4 

3.65 

13.8 

8.59 

173 

1  lb. 

16 

454 

58.5 

220.9 

137.4 

2772 

Clams,  (edible  portion)  

1  serving 

3H 

100 

8.6 

1.0 

2.0 

51 

Clam  Bouillon  

1  serving 

100 

0.2 

0.2 

2 

u  a 

1  quart 

32 

906 

2.0 

'o.s 

1.6 

23 

Claret  (10%  Alcohol)  

1  tbsp. 

Vi 

14 

10 

Cocoa  

1  tbsp. 

V4, 

7+ 

1.5 

2.0 

2.5 

35 

1  serving 

3H 

100 

16.5 

0.4 

70 

u  u 

1  lb. 

16 

454 

74.8 

1.8 

315 

Cod  Fish,  Salt,  Boneless  

1  serving 

2 

57 

15.7 

0.2 

64 

1  lb. 

16 

454 

125.6 

1.4 

515 

66 


PRACTICAL  DIETETICS 


FOOD  MATERIAL 
(Uncooked) 

Measure 

Weight 

Protein 

Fat 

Carbo- 
hydrates 

Fuel  Value 

Calor- 

C— (Continued) 

Ozs, 

Guis. 

Gms. 

Gms. 

Gms. 

ies 

1  teaspoon 
.... 

.388 

11 

0.88 

1.057 

6.07 

37.31 

28  35 

9  07 

2 . 72 

15 .66 

u  u 

1  can 

10 

'tjyj 

OO.  oo 

43 . 75 

250 . 6C 

i  d1  Q 
loll.o 

1  serving 

100 

2.5 

0.4 

12 

1  quart 

32 

906 

10.0 

1.6 

46 

1  cup 

10 

28.4 

7.9 

3.4 

53.9 

278 

1  tbsp. 

Vz 

10 

0.8 

0.2 

7.1 

33 

1  cup 

5 

142 

13.0 

2.6 

106.8 

504 

1  tbsp. 

Vz 

10 

9.5 

3g 

1  cup 

156 

148.2 

592 

Cracker  Crumbs 

1  cup 

CI 

1  CI 

10. o 

9.0 

110.2 

1  large 

H 

10 

1.2 

0.5 

7.6 

40 

Cream,  Thin  (18%).  

1  tbsp. 

14 

0.4 

2.8 

0.7 

29 

1  cup 

8 

227 

5.6 

41.9 

10.2 

440 

Thick  (40%)  

u            u  u 

1  tbsp. 

8 

14 

0.3 

6.0 

0.5 

57 

1  cup 

227 

A.  GO 

on  T 

O.o 

864 

Cucumbers,  Fresh  (edible  port'n). 

1 

28.4 

23 

.06 

.89 

1  cup 

5 

142 

2.12 

18 

81 

Dried  

1  cup 

8 

227 

5.44 

84 

72S 

D 

1  cup  (with 

8 

227 

4.0 

5.6 

160.8 

710 

stones) 

Dry  Peptonoids,  Soluble  

1  tbsp. 

2 

159 

6 

8 

57 

E 

Eggs,  whole  average  size  (without 

shell ) 

1 

45 

5.4 

4.2 

6a 

Eggs,  White  

«  Yolk  

1 

25 

3.3 

13 

1 

13 

2.1 

*4!s 

48: 

P 

1  tbsp. 

H 

10 

1.0 

0.1 

7.2 

34 

1  cup 

6 

170 

18.7 

2.3 

129.8 

616 

Figs  

Ifig 

1 

28.4 

1.3 

0.1 

22.2 

9S 

Hlb. 

8 

227 

9.7 

0.7 

168.2 

718- 

Filberts,  Shelled  

«  a 

1  lb. 

16 

454 

70  72 

296.16 

58.88 

3184 

1  doz. 

3.3 

13.89 

2.76 

150 

«  a 

1  tbsp. 

2  21 

9.26 

1.84 

100 

("chopped) 

ESTIMATES  OF 


FOOD  VALUES 


67 


FOOD  MATERIAL 

(Uncooked) 


F— (Continued) 
Flour,  Barley  

a  « 

«     Gum  Gluten  

tt  «  « 

«  Graham  

a  " 

«     Rice  V  

"  Rye  

«  Wheat  "(Rolier  Process) 

u  u  u  u 

Fowl,  (edible  portion)  

a  «  « 

G 

Gelatin,  Granulated  

«  Shredded  

Gum  Gluten  Flour  

u  a  a 

«  Bread!!;;;!!!!!! 

a  «  M 

«  "  Biscuit  Crisp.... 
"         "  Noodles  

Greens  

Grapes,  Malaga  

u  u 

Grape  Juice  

u  u 

H 

Haddock,  (edible  portion)  

Halibut,  (edible  portion)  

Ham,  Fresh,  Lean  

u  u  u 

Hickory  Nuts,  Shelled  


Measure 

Weight 

Protein 

Fat 

Carbo- 
hydrates 

Fuel  Value 

"■ 

Calor^ 

Ozs. 

Gms, 

Gms. 

Gms. 

Gms. 

ies 

1  tbsp. 

16 

1.3 

0.2 

12.5 

57 

227 

19.0 

2.5 

174.3 

796 

1  tbsp. 

8 

3  46 

12 

3.48 

29 

1  cup 

5 

142 

60 ' 

2!3 

63' 

512.7 

1  tbsp. 

H 

8 

1.3 

0.2 

6.8 

34 

c 

J 

142 

18.8 

3.2 

101.2 

509 

1  tbsp. 

1^ 
72 

16 

1  4 

0.04 

10.2 

58 

01/ 

0/2 

241 

18  9 

0  7 

187 .8 

870 

1  fvF 
1  tDSp. 

}4 

8 

yj .  J 

0  07 

6  3 

28 

5 

142 

Q  f\ 

1  3 

111  5 

496 

1  tbsp 

8 

n  Q 

0  08 

6.0 

28 

1  cup 

5 

142 

15.9 

l!4 

106!  2 

500 

1  serving 

100 

19.3 

16.3 

224 

lib. 

16 

454 

87.5 

73.9 

1015 

1  tbsp. 

a/ 

VI 0 

8.5 

/ .  0 

31 

1  box 

IH 

34' 

31.1 

125 

H  box 

17 

15.6 

62 

1  tbsp. 

H 

8 

3.46 

.12 

3.48 

29 

1  cup 

5 

142 

60 

2.3 

63 

512.7 

1  IK 
1  ID. 

16 

450 

191 

7  3 

200 

1629  7 

1  slice 

1 

28.4 

8.4 

!30 

8.5 

70!  3 

1  loaf 

13 

386.5 

114 

4 

116.3 

.937.2 

1  biscuit 

1  / 

2 . 94 

13 

3  15 

2S  5 

1  cup 

100 

45 

4!2 

32!5 

350 

1  serving 

4 

113 

2 . 3 

0  3 

3  6 

LI 

1  dozen 

2 

57 

0.74 

0.9 

10.88 

55 

1  ID. 

16 

454 

4.5 

5.4 

00 . 0 

328 

1  tbsp. 

1/ 

72 

14 

3  8 

1  cup 

8 

227 

60.0 

240 

1  serving 

100 

17.2 

0.3 

72 

1  lb. 

16 

454 

77.9 

1.36 

324 

1  serving 

3H 

100 

18.6 

5.2 

121 

1  lb. 

16 

454 

84.3 

23.5 

549 

1  serving 

33^ 

100 

24.8 

14.2 

227 

1  lb. 

16 

454 

112.6 

64.4 

1029 

lib. 

16 

454 

69.76 

305.6 

51.68 

3234 

Mcup 

IH 

6.54 

28.5 

4.83 

303 

(chopped) 

1  tbsp. 

2.18 

9.5 

1.61 

101 

(chopped) 

68 


PRACTICAL  DIETETICS 


FOOD  MATERIAL 
(Uncooked) 

Measure 

Weight 

Protein 

Fat 

Carbo- 
hydrates 

Fuel  Value 

Calor^ 

H — ( Continued  ) 

Ozs. 

Gms. 

Gms. 

Gms. 

Gms. 

ies 

1  tbsp. 

1^ 

72 

14 

1 . 2 

0.1 

11.2 

50 

1  cup 

8 

227 

18.9 

1.4 

179.2 

805 

1  tbsp. 

1 

28.35 

.13 

23.0 

92 

J 

Jell-0  

1  box 

3.5 

100 

11.2 

^86.4 

395 

1  serving 

16 

1 .9 

14.4 

66 

K 

Kumy  ss  

1  qt. 

34.4 

975 

2.2 

2.1 

1.5 

328 

L 

1  serving 

3^ 

100 

18.7 

28.3 

329 

1  lb. 

16 

454 

84.8 

128.3 

1494 

1  tbsp. 

0.5 

14 

14 

127 

« 

1  lb. 

16 

454 

484 

4083 

3  tbsp. 

42 

4.2 

17 

Lentil  Flour 

1  tbsp. 

Vio 

9 

2.3 

0.9 

5  .3 

31 

1  cup 

5 

144 

37.0 

1.4 

85.0 

500 

1  head 

8 

227 

2.3 

0.5 

5.7 

36 

1  IDSp. 

1^ 

72 

15 

u .  o 

2.1 

28 

Lobster,  (edible  portion)  *. 

1  serving 

6X2 

100 

1  fi  1 

1 . 1 

0.5 

84 

1  IK 
X  ID. 

10 

454 

82 .08 

4.96 

2.24 

382 

M 

1  cup 

108 

14.7 

1.0 

81.1 

392 

Mackerel,  Fresh  (edible  portion) . . 

1  serving 

11/ 

100 

18 . 7 

7. 1 

139 

lib.  / 

16 

454 

84.8 

32.16 

629 

1  serving 

33^ 

100 

16.3 

17  4 

222 

lib. 

16 

454 

73.9 

78.9 

1007 

Malted  Milk,  Horlick's  

1  tbsp. 

14 

2.3 

1.2 

9.5 

59 

Milk,  Whole  

1  tbsp. 

0.7 

20 

.06 

0.8 

1.0 

14 

1  cup 

8.6 

244 

8.0 

9.3 

12.2 

169 

1  quart 

34.4 

975 

32.2 

39.0 

48.8 

675 

"  Skimmed  

1  tbsp. 

0.7 

20 

0.7 

0.06 

1.0 

7 

u  u 

1  cup 

8.6 

244 

8.3 

0.7 

12.5 

89 

1  quart 

34.4 

975 

33.1 

2.9 

49.7 

358 

1  tbsp. 

27 

0.6 

18.7 

77 

1  cup 

11 

317 

7.6 

219.7 

909 

Mutton  Chops  

1  serving 

3K 

100 

16.0 

33.1 

362 

Mb. 

16 

454 

72.5 

150.1 

1640 

ESTIMATES  OF  FOOD  VALVES 


69 


FOOD  MATERIAL 
(Uncooked) 

Measure 

Weight 

Protein 

Fat 

Carbo- 
hydrates 

Fuel  Value 

CaloT' 

N 

Ozs. 

Gms. 

Gms. 

Gms. 

Gms. 

ies 

Noodles  Gluten 

1  cup 

6X2 

45 

4.2 

32.5 

434 

0 

Oatmeal,  Granulated  

1  tbsp. 

14+ 

1.8 

0.9 

9.9 

55 

1  cup 

8 

227 

28.8 

14.7 

158.2 

880 

Oats,  Rolled  

1  tbsp. 

5 

0.7 

0.3 

2.7 

16 

1  cup 

23^ 

71 

11.8 

5.2 

46.9 

282 

Olive  Oil,  Nicelle  

1  tbsp. 

15 



15 

135 

2  or  3 

0.5 

14 

0.1 

2.8 

1.2 

31 

Onion 

1  serving 

4 

113 

1.8 

0.3 

11.2 

56 

Orange 

1  medium 

5 

142 

1.2 

0.3 

17.4 

77 

Orange  Juice  

1  tbsp. 

14 

1.6 

6 

1  cup 

8 

227 

25.6 

104 

2 

1 

28.4 

1.7 

0.3 

1.0 

14 

1  cup 

6 

170 

10.5 

2.0 

6.3 

84 

(solid) 

P 

1  tbsp. 

15 

I 

2.5 

30 

1  A' 

1  meQium 

113 

0  8 

0  1 

113 

50 

Dried  

1  cup 

3 

85 

1.4 

1^8 

56^2 

247 

1  tbsp. 

8 

14 

1.1 

5 

1  cup 

227 

17.6 

80 

1  cu 

C  - 

142 

oO . 

J't.  1 

34.55 

777 

1  tbsp. 

0.6 

16  ^ 

4.8 

7.7 

2.8 

100 

1  serving 

113 

7  7 

U .  0 

io  A 
IV .  0 

114 

1  cup 

184 

6.6 

0.4 

18.0 

100 

1  tbsp. 

*'/io 

9 

2.3 

1 .0 

5.8 

33 

1  cup 

5 

144 

36.9 

1.5 

93.0 

533 

1  cup 

5.5 

156 

15.0 

110.0 

23.8 

1145 

Pineapple,  Fresh  (edible portion). 

8 

227 

0.9 

0.7 

22 

98 

1  slice 

3 

85 

.4 

.6 

31 

130.5 

1  cup 

8 

227 

0.9 

1.6 

82.6 

348 

a  u 

1  can 

24 

680 

2.6 

4.8 

247 

1044 

Port  Wine  (10%'Alcohol)  

1  tbsp. 

14 

10 

Potatoes,  White  

1  rqedium 

6 

100 

2.2 

0.1 

18.4 

83 

1  medium 

100 

1.8 

0.7 

27.4 

123 

Prunes  

1  cup 

5 

142 

2.5 

88.1 

363 

u 

3  prunes 

1 

28.4 

0.5 

17.6 

72 

¥0  PRACTICAL  DIETETICS 


FOOD  MATERIAL 
(Uncooked) 

Measure 

Weight 

Protein 

Fat 

Carbo- 
hydrates 

Fuel  Value 

Calor- 

Q 

Ozs. 

Gms, 

Gms. 

Gms. 

Gms. 

ies 

1  serving 

100 

21.8 

8.0 

159 

R 

1  dozen 

9 

0.2 

0.3 

6.5 

29 

1  cup 

4 

113 

2.6 

3.4 

77.6 

352 

Raspberries,  Fresh,  Black, 

(edible  portion) . . 

1  cup 

5 

142 

2.4 

1.4 

17.8 

94 

1  cup 

8 

227 

22.6 

90 

1 

28.4 

0.2 

0.2 

1.0 

6 

tt 

16 

454 

2.7 

3.2 

16.3 

105 

1  tbsp. 

15 

\  \ 

0  04 

11.2 

50 

U 

1  cup 

240 

18!l 

0:7 

179!l 

795 

1  tbsp. 

14 

38 

s 

a                u  u 

1  serving 

100 

22 

12.8 

203 

lib. 

16 

454 

99.6 

57.9 

922 

Saltines  

1  wafer 

H 

3 

0.4 

0.5 

2.4 

15 

1  serving 

100 

23 

19.7 

269 

1  can 

16 

454 

104.3 

89.2 

1221 

u             u  u 

1  serving 

100 

18.8 

9.5 

161 

lib. 

16 

454 

85.1 

43.0 

729 

"  Roe  

1  serving 

100 

20.9 

3.8 

26 

128 

Sherry  

1  tbsp. 

72 

14 

13 

1  serving 

4 

\4 

Z3 

2,3 

0.3 

3.6 

27 

1  serving 

3^ 

100 

16.3 

36.2 

391 

1  serving 

3>^ 

100 

1.4 

0.5 

9 

46 

1  serving 

4 

113 

1.0 

0.7 

7.9 

42 

1  cup 

6 

170 

1.5 

1.0 

11.9 

63 

1  cup 

8 

227 

11.4 

45 

Suet  

1  tbsp. 

14 

.66 

11.59 

107 

1  lb. 

16 

454 

21.28 

371.0 

3425 

Sugar,  Granulated..'  

u  u 

1  tbsp. 

15 

15.0 

848 

1  cup 

210 

210 

«  Loaf  

1  lump 

0.4 

7.6 

7.6 

30 

1  cup 

6.5 

184 

184 

736 

1  tbsp. 

12 

12 

48 

u  u 

1  cup 

6.5 

184 

184 

736 

ESTIMATES  OF  FOOD  VALUES  71 


FOOD  MATERIAL 
(Uncooked) 

Measure 

Weight  . 

Protein 

a 

Carbo-  - 
hydrates 

Fuel  Value 

Calor~ 

S— (Continued) 

uzs. 

LrUlS. 

Gms. 

LxTnS. 

t6S 

1 

lUU  /o 

4  1 

1  teaspoon 

' ' 'm 

5 

100% 

20^5 

(aver,  size) 

"         "  "   

1  tbsp 

564 

16 

65.6 

1  serving 

100 

16.8 

12 

\ 

176 

lib. 

16 

454 

76.2 

54 

8 

798 

1  pair 

8 

227 

38.1 

27 

4 

399 

T 

(med.  size) 

Tomatoes  

1  tbsp. 

8 

15 

0.2 

0 

03 

0.6 

4 

1  cup 

227 

2.7 

0 

5 

9.0 

51 

u 

1  medium 

5 

142 

n 

yj .  J 

0 

3 

3  0 

16 

u 

(whole  to- 

mato) 

Tapioca,  Pearled  

1  tbsp. 

14 

0.03 

12.3 

49 

1  cup 

6.5 

184 

0.4 

159.5 

640 

1  tbsp. 

1/ 

72 

1  A 
I't 

0 . 03 

12 . 2 

tt                  u  u 

1  serving 

100 

17.8 

10 

3 

164 

1  lb. 

16 

454 

80.6 

46 

7 

743 

1  serving 

3H 

100 

1.3 

0 

2 

8.1 

39 

Turkey,  (edible  portion) 

1  serving 

33^ 

100 

21.1 

22 

9 

290.5 

lib. 

16 

454 

95.7 

103 

9 

1317 

W 

Walnuts,  English  

u  tt 

1  cup 

156 

25.8 

98 

8 

25.1 

1093 

1  meat 

1 

.17 

0 

63 

0.16 

7 

Whey  

1  glass 

184 

1.8 

0 

5 

9.3 

50 

Whitefish,  (edible  portion)  

1  serving 

3H 

100 

22.9 

6 

5 

150 

1  lb. 

16 

454 

103.8 

29 

4 

681 

-  The  weights  assigned  to  the  various  measurements  in  this  table  have 
been  determined  carefully,  but  are  the  results  of  a  limited  number  of 
experiments,  and  hence  must  be  regarded  as  only  approximate.  The  food 
values  are  given  with  sufficient  accuracy  to  be  within  the  limits  of  error 
of  computations  made  on  average  analysis  of  food-stuffs. 


CHAPTEE  IV 


FEEDING  THE  SICE 

GENERAL  RULES 

In  the  treatment  of  disease  there  are  few  questions  which 
have  to  be  considered  so  often  in  the  daily  routine  of  practice 
as  those  which  concern  the  proper  support  and  nourishment  of 
the  patient. 

A  good  nurse  will  never  exceed  or  depart  from  the  phy- 
sician^s  instructions ;  but  there  are  occasions  when  her  posses- 
sion of  accurate,  even  if  limited,  knowledge  on  the  subject 
of  chemical  and  physiological  action  of  food  will  enable  a 
physician  to  give  more  definite  directions,  greatly  assisting 
him  in  the  performance  of  his  duties,  and  adding  to  the  com- 
fort and  well-being  of  the  patient. 

PJiysiciav/s  Directions.  The  nurse's  directions  in  refer- 
ence to  feeding  her  patient  should  be  written,  stating  how 
much  food  may  be  given,  its  form,  preparation  and  time  of 
serving.  In  pneumonia,  typhoid  and  all  acute  serious  con- 
ditions, a  record  of  all  these  details  should  be  kept,  also  a 
record  of  the  quantity  of  fluid  and  medicine  taken. 

The  nurse  has  a  far  better  opportunity  than  the  physician 
to  judge  of  all  the  conditions  of  the  patient's  digestion,  and 
his  likes  and  dislikes  for  different  foods,  and  she  should  not 
fail  to  report  them  to  the  physician  in  charge  and  under- 
stand very  definitely  to  what  extent  she  is  to  be  permitted  to 
humor  her  patient,  and  substitute  one  form  of  food  or  drink 
for  another. 

It  may  happen  from  lack  of  care  or  indefinite  instruction, 
that  the  food  served  will  neutralize  the  effect  of  the  med- 
icine, either  by  overfeeding,  or  by  irregularities  in  feeding, 

72 


FEEDING  THE  SICK 


73 


which  disturb  digestion  and  interfere  with  the  beneficial  ef- 
fect of  the  medicine. 

Those  who  are  ill  are  often  allowed  to  drift  into  critical 
conditions  through  not  being  properly  supplied  with  such 
nutritive  material  as  their  enfeebled  powers  can  digest. 
Many  have  perished  because  those  around  them  did  not  know 
how  to  feed  them,  and  either  withheld  food  altogether,  or 
gave  that  which  was  unsuitable,  through  ignorance.  Even 
when  the  patient  is  confined  to  bed  and  prevented  from  tak- 
ing any  kind  of  voluntary  exercise,  he  still  requires  energy  for 
the  involuntary  action  of  heart,  lungs,  and  the  other  processes 
of  living,  and  healthy  nutrition  must  be  provided  for  by  a 
supply  of  suitable  food. 

Often  the  nurse  may  conscientiously  serve  one  form  of 
food  ordered,  offering  it  in  spite  of  the  patient's  dislike  and 
nausea  with  the  result  of  half  starving  him.  When  her  in- 
structions have  not  been  specific,  or  have  not  provided  for 
emergencies,  she  should  make  it  a  point  to  have  them  clearly 
understood  at  the  next  visit  of  the  physician. 

To  be  able  to  carry  out  these  instructions  and  offer  nourish- 
ment intelligently,  a  thorough  practical  knowledge  of  dietetics 
is  necessary,  and  should  be  the  foundation  of  every  nurse's 
training.  If  we  wish  to  succeed  in  avoiding  nausea,  vomit- 
ing, loss  of  strength,  and  even  loss  of  life,  we  must  learn  to 
offer  food  to  the  patient  in  a  suitable  form,  in  the  quantity 
and  at  the  times  suited  to  his  digestive  power,  and  so  adapt 
his  food  to  his  capabilities.  . 

This  subject  has  been  so  ably  treated  by  Dr.  Thompson 
(Practical  Dietetics,  2d  ed.)  in  his  chapter,  "Administration 
of  Food  for  the  Sick,'^  that  permission  has  been  asked,  and 
kindly  granted,  to  use  extracts  from  that  chapter;  also,  by 
the  kindness  of  Mrs.  Ellen  H.  Eichards,  quotations  have  been 
made  from  the  article,  "  Nourishment  in  Acute  Disease,'^  from 
the  "  Eumford  Kitchen  Leaflets.'' 

Feeding  in  Acute  Disease.  The  preparation  of  food  for 
those  who  are  seriously  ill  is  a  matter  of  vital  importance, 
for  the  life  of  the  patient  often  depends  either  upon  the 


74 


PRACTICAL  DIETETICS 


maintenance  of  strength  during  the  acute  period  of  the  dis- 
ease or  on  the  recovery  of  power  during  convalescence.  Since 
acute  disease  is  accompanied  by  fever^  we  must  consider  the 
effect  of  feeding  in  cases  where  the  temperature  is  febrile  in 
character;  also  the  amount  of  food^  its  quality  and  quantity, 
together  with  other  conditions  affecting  its  absorption. 

In  acute  disease  accompanied  by  fever,  what  are  the  con- 
ditions? The  body  loses  weight,  urea  is  increased  and  car- 
bonic acid  and  water  are  excreted  in  larger  amounts  than  in 
health.  All  of  this  loss  is  not  dangerous  if  permitted  to  go 
on  for  a  few  days  only,  and  if  the  amounts  do  not  exceed 
certain  limits.  But  to  replace  these  losses  we  are  at  a  dis- 
advantage as  regards  the  ability  of  the  system  to  assimilate 
food.  In  fevers  the  appetite  is  small,  or  may  be  completely 
lost.  The  saliva,  the  gastric  juice,  pancreatic  fluid,  the  bile, 
are  less  efficient  in  action  or  diminished  in  amount  during 
high  temperature. 

The  stomach  is  very  sensitive^  in  part,  perhaps,  through 
sympathy  with  the  increased  sensitiveness  of  the  nervous  sys- 
tem as  a  whole.  If  there  is  much  hyperaesthesia  of  the  diges- 
tive tract,  as  in  typhoid,  in  peritonitis,  in  dysentery  or  gastro- 
enteritis, one  must  be  careful  not  to  give  too  much  food  at 
a  time,  and  it  should  be  in  a  liquid  form  and  partially  pre- 
digested.    Note  Typhoid  Diet,  page  337. 

Evidences  of  Digestion.  Our  attention  should  be  devoted 
not  only  to  what  is  put  into  the  alimentary  canal,  but  also  to 
what  goes  out.  For  instance,  if  curds  of  undigested  milk 
are  found  in  the  stools  of  a  typhoid  patient,  the  quantity  of 
milk  should  be  diminished,  or  it  should  be  diluted. 

Every  careful  observer  of  the  sick  will  agree  that  many 
patients  are  starved,  simply  from  the  want  of  attention  to 
the  means  which  alone  make  it  possible  for  them  to  take 
food.  For  example,  if  the  patient  has  a  fever  with  remis- 
sion and  intermission,  it  is  of  the  first  importance  to  remem- 
ber that  the  ability  to  digest  food  at  these  intermissions  is 
greater,  and  it  is  then  that  the  most  nourishing  portions  of 
diet  should  be  given. 


FEEDING  THE  SICK 


75 


It  must  be  borne  in  mind  that,  contrary  to  the  prevalent 
notion,  the  increase  of  body  heat  is  not  entirely  responsible 
for  the  wasting  of  the  fever  patient.  The  emaciation  is  due 
partly  to  the  inability  to  receive  and  digest  the  food,  which 
in  turn  arises  from  the  irritable  state  of  the  stomach  and 
bowels  and  the  defective  secretion  of  the  digestive  fluids. 

It  is  the  administration  of  unsuitable  food  that  must  be 
guarded  against,  and  also  the  giving  of  nourishment  in 
quantities  and  at  times  unsuited  to  the  digestive  powers  of 
the  patient.  All  food  is  changed  into  liquid  in  the  process 
of  digestion  before  it  can  be  absorbed  into  the  blood.  Liquid 
food,  therefore,  is  given  to  the  very  sick  because  it  can  be 
digested  with  the  smallest  amount  of  labor  to  the  body. 

Predigested  milk  possesses  the  decided  advantage  in  that 
it  aids  the  assimilation  of  the  milk  without  adding  to  its 
bulk,  as  do  lime  water  and  other  substances. 

By  diluting  milk,  stimulants  and  gruels  too  much,  the 
quantity  of  the  fluid  is  so  great  that  the  patient  soon  tires 
of  swallowing,  and  stops  before  enough  nourishment  has  been 
obtained.  One  should  not  give  what  cannot  be  digested,  nor 
less  than  can  be  assimilated.  So  the  attendant  must  have  a 
constant  watch  over  the  condition  of  the  patient's  powers  of 
digestion,  and  it  is  necessary  for  her  to  know  how  to  choose 
such  variety  in  the  diet  as  to  include  both  what  is  palatable 
and  what  will  afford  a  proper  amount  of  nourishment. 

The  Appetite,  As  the  appetite  of  the  sick  often  requires 
tempting,  the  greatest  pains  should  be  taken  in  the  prepara- 
tion of  the  invalid's  food.  The  lack  of  desire  for  food  may 
be  due  merely  to  defective  cooking,  to  the  serving  of  meals  at 
inopportune  moments,  or  to  the  fact  that  the  food  selected 
is  not  to  the  patient's  liking  in  kind,  flavor,  or  appearance. 
A  desire  for  food  may  exist,  but  not  for  the  particular  food 
offered,  and  it  is  the  province  of  the  nurse  to  differentiate. 

Punctuality  in  serving  meals  should  be  carefully  observed, 
for  an  appetite  ready  at  the  accustomed  hour  may  fail  if  the 
meal  is  delayed.  There  is  much  unconscious  habit  in  re- 
gard to  eating.    Time  for  cooking  food  should  be  carefully 


76 


PRACTICAL  DIETETICS 


considered  with  regard  to  the  time  for  serving.  Many  foods 
properly  cooked  are  spoiled  by  standing,  which  if  served 
promptly  would  be  delicious.  The  rule  of  serving  food  at 
stated  intervals  should  be  observed  for  the  conscious  as  well 
as  the  unconscious  or  semi-unconscious  patient. 

Quality  and  Quantity  of  Food.  All  foods  supplied  should 
be  as  pure  and  fresh  as  possible.  Hence  for  the  sick  it  is 
desirable  to  select  the  best  quality  obtainable. 

The  amount  should  be  regulated  by  the  physician.  When 
this  is  not  done,  care  must  be  taken,  on  the  one  hand  to  see 
that  sufficient  is  eaten,  which  often  necessitates  tempting  the 
appetite;  and  on  the  other  to  avoid  overindulgence  if  the 
patient  is  voracious  or  has  a  fancy  for  certain  articles  of 
which  large  amounts  are  likely  to  be  harmful. 

A  well  man,  lying  quietly  in  bed,  requires  from  1600  to 
2000  calories  per  day,  and  if  the  body  is  being  wasted  by 
disease,  he  may  need  a  great  deal  more.  During  conva- 
lescence, if  the  body  has  lost  weight,  food  must  be  given 
for  rebuilding,  in  addition  to  the  ordinary  daily  need. 

Temperature  of  Food.  The  temperature  of  the  food  served 
is  exceedingly  important,  as  it  has  a  marked  influence  upon 
digestion.  As  a  rule,  foods  to  be  served  ^^hot^^  should 
neither  be  served  lukewarm  nor  too  hot.  Serve  in  hot  dishes 
and  cover  in  transit.  Cold  food  should  be  served  neither 
lukewarm  nor  ice  cold.  Under  many  conditions  food  at  ex- 
treme temperatures  interferes  with  digestion  and  absorption. 

Details  in  Feeding.  The  patient  should  be  saved  from 
thinking  as  well  as  from  physical  exertion,  and  it  is  unwise 
to  ask  him  what  he  would  like  to  eat,  for  it  is  often  the  un- 
expected that  pleases.  Personal  idiosyncrasies  should  be  con- 
sidered; for  some  foods  easy  of  digestion,  if  repugnant  to 
the  patient,  may  prove  nauseating  and  be  rejected  or  disturb 
digestion. 

Only  a  small  quantity  of  food  should  be  given  at  one  time 
so  that  the  digestive  organs  may  not  be  overtaxed.  It  is 
much  better  to  do  this  often  than  to  give  too  much  at  one 
time.    A  tablespoonful  of  nourishment  every  half  hour  may 


FEEDING  THE  SICK 


77 


be  retained  and  digested,  and  do  the  patient  good,  when  if 
a  larger  amount  were  given  the  stomach  would  reject  it. 

The  majority  of  weak  patients  are  unable  to  take  food  of 
any  solid  kind  before  eleven  o'clock  in  the  morning,  yet 
before  that  time  comes  they  are  apt  to  become  exhausted. 
This  would  not  be  likely  to  occur  if  a  spoonful  of  some  liquid 
nourishment  or  stimulant  ordered  by  the  physician  were  given 
every  hour  or  two,  from  the  early  morning  up  to  the  time 
for  taking  the  solid  food,  which  the  patient  would  then 
probably  be  able  to  do  by  noon. 

All  noise  in  the  preparation  of  food  and  smell  of  cook- 
ing should  be  kept  from  the  sick  room.  The  nurse  should 
never  eat  her  meal  or  taste  the  patient's  food  in  his  presence, 
and  should  always  have  a  cheerful  manner  and  a  cleanly, 
tidy  appearance.  These  things  have  much  effect  upon  the 
patient's  appetite. 

Bathing  and  Cleansing  the  Mouth,  When  possible,  it  is 
well  to  bathe  the  patient's  face  and  hands  before  offering  a 
meal.  The  mouth  should  be  rinsed  each  time  after  eating 
with  pure  water,  or  diluted  borax  water  (two  teaspoonfuls 
to  a  tumbler  of  water).  This  takes  away  the  after-taste  of 
the  food  and  he  is  less  apt  to  tire  of  it. 

The  mouth  should  be  kept  thoroughly  cleansed,  for  if  the 
lips  are  allowed  to  become  parched  and  sour,  the  patient  will 
refuse  nourishment  which  he  might  otherwise  take.  When  a 
patient  cannot  rinse  his  own  mouth  it  must  be  frequently 
cleansed  by  the  nurse  with  a  swab  of  fresh  cotton,  fastened  to 
a  small  flexible  stick.  A  tongue  scraper  made  of  a  whale- 
bone bent  to  a  loop  may  be  used  before  serving  the  food; 
thus  the  taste  nerves  will  be  uncovered  and  the  appetite  im- 
proved. 

Time  and  Position  for  Feeding.  When  the  patient  is  first 
allowed  to  sit  up  for  half  an  hour,  it  is  well  to  utilize  this 
time  for  giving  the  principal  meal  of  the  day,  which  is  likely 
to  be  eaten  with  more  relish,  and  perhaps  better  digested  in 
consequence.  If  the  patient  is  only  allowed  to  partially  sit 
up  in  bed,  the  nurse  should  see  that  the  position  is  com- 


78 


PRACTICAL  DIETETICS 


fortable,  and  that  the  food  tray  does  not  cramp  the  arms  and 
legs,  taking  care  that  no  crumbs  get  into  the  bed. 

Sleep  and  Feeding,  The  awakening  of  a  patient  to  take 
nourishment  depends  upon  his  need  of  the  nutriment  and 
upon  his  ability  to  go  to  sleep  again.  In  serious  cases  it 
should  be  given  at  stated  intervals  if  the  patient  drops  to 
sleep  easily  after  taking  it.  Some  patients,  however,  are  an- 
noyed by  being  awakened  and  cannot  sleep  again.  In  such 
cases  it  may  be  that  the  sleep  will  be  more  beneficial  than 
food. 

Feeding  the  Helpless  Patient.  The  effort  of  sitting  up 
may  become  fatiguing  to  the  invalid  and  so  destroy  his  appe- 
tite before  the  meal  is  half  done,  or  he  may  not  be  able  to 
feed  himself,  or  to  raise  his  head.  In  such  cases  the  diffi- 
culty can  be  obviated  by  placing  the  hand  beneath  the  pillow 
and  raising  both  together  gently. 

In  feeding  fluids  at  these  times  always  serve  in  small 
tumbler,  not  more  than  two-thirds  filled;  see  that  swallows 
are  not  taken  during  inspiration,  and  that  each  mouthful  is 
swallowed  before  another  is  offered.  In  case  the  head  cannot 
be  raised,  food  may  be  given  by  means  of  a  glass  tube  or  a 
feeding  cup. 

Feeding  the  Unconscious  Patient.  The  feeding  of  uncon- 
scious patients  demands  especial  care.  They  should  be  given 
only  liquid  nourishment^  and  fed  with  a  spoon,  or  through 
a  catheter.  If  the  jaws  are  set,  a  medicine  dropper  may  be 
utilized ;  not  over  a  teaspoonf ul  should  be  given  at  once,  and 
the  nurse  must  be  sure  it  is  swallowed  before  she  gives  more. 
In  the  case  of  comatose  children,  or  young  infants,  the  nour- 
ishment may  be  poured  into  the  nostril  in  place  of  the  mouth. 
Feeding  with  the  stomach  tube  is  sometimes  resorted  to,  when 
nasal  feeding  is  not  feasible. 

Forced  Feeding.  Forced  feeding  consists  in  introducing 
various  liquid  foods,  as  milk,  eggs,  meat-juice  or  extracts 
into  the  stomach  by  way  of  the  nose  or  directly  through  the 
mouth  by  means  of  a  stomach  tube.  This  is  seldom  required 
of  the  nurse,  but  is  usually  done  by  the  physician  himself* 


FEEDING  TEE  SICK 


79 


This  method  is  employed  when  the  unconscious  patient  expe- 
riences difficulty  in  swallowing ;  in  gastric  irritability ;  when 
a  patient  is  unable  to  take  sufficient  food,  owing  to  loss  of 
appetite  and  disgust  for  food;  and  also  in  case  of  a  refrac- 
tory patient  who  refuses  to  eat. 

Nasal  Feeding.  In  nasal  feeding  a  nasal  tube  is  em- 
ployed or  in  case  of  infant  a  catheter.  Have  either  well 
oiled  and  passed  gently  through  the  nose  into  the  oesophagus 
and  then  into  the  stomach.  Before  pouring  in  the  food  wait 
a  moment  to  see  that  the  tube  has  not  entered  the  larynx. 

Use  of  the  Stomach  Tube.  The  jaws  must  be  kept  open. 
In  children  without  teeth,  the  finger  may  be  employed;  in 
grown  persons  a  mouth  gag  or  a  roller  bandage  may  be  held 
between  the  teeth.  The  tube  should  be  moistened,  passed 
into  the  pharynx  and  thence  rapidly  into  the  stomach.  If 
these  two  precautions  are  not  observed,  contraction  of  the 
muscles  may  occur,  preventing  the  tube  from  entering  the 
oesophagus.  In  passing  the  tube  into  the  oesophagus,  hold 
it  well  back  from  the  end.  A\T.ien  the  tube  is  satisfactorily 
introduced,  place  a  funnel  in  the  free  end  and  pour  liquid 
nourishment  slowly  down  the  side  of  the  funnel  until  the 
tube  is  filled,  and  the  air  in  tube  is  expelled;  this  care  pre- 
vents the  air  in  tube  entering  the  stomach.  In  removing  the 
tube,  it  should  be  withdrawn  rapidly  in  order  not  to  excite 
vomiting.  In  some  cases  the  physician  orders  the  stomach 
washed  out  before  introducing  the  food.  When  it  is  neces- 
sary to  take  special  precautions  to  prevent  regurgitation  of 
the  food,  the  ribs  may  be  tickled  to  prevent  contraction  of 
the  diaphragm. 

Rectal  Feeding.  This  form  of  alimentation  is  necessary 
when  the  stomach  cannot  retain  food.  It  is  based  on  the  fact 
that  the  rectal  mucous  membrane,  while  it  possesses  no  di- 
gestive faculty,  is  able  to  absorb  certain  classes  of  nutriment. 
These  include  among  the  carbohydrates,  sugars;  among  pro- 
teins, the  native  albumin  as  well  as  the  end  products  of  pro- 
tein digestion.  The  latter  are  believed  to  be  much  more 
absorbable  than  the  first  products  (albumoses  and  peptones). 


80  PRACTICAL  DIETETICS 


Soluble  starch  (dextrin)  is  doubtless  absorbable^  but  un- 
changed starch  and  fats  can  hardly  be  taken  up.  It  is  prob- 
able that  finely  emulsified  fats  if  thrown  well  up  into  the 
colon  are  absorbable  to  some  extent.  Although  we  cannot 
understand  why  certain  substances  nourish  the  patient,  since 
they  are  theoretically  not  absorbable,  they  seem  in  some  man- 
ner to  be  utilized,  even  when  merely  thrown  into  the  rectum. 
As  far  as  possible  we  should  employ  substances  which  we 
know  positively  to  be  capable  of  absorption;  but  in  rectal 
feeding  for  a  long  period  it  is  sometimes  necessary  to  use  a 
great  variety  of  formula,  making  it  out  of  the  question  to 
confine  ourselves  to  the  few  articles  which  are  theoretically 
best  suited  for  the  purpose. 

The  rectum  may  be  intolerant  to  almost  any  form  of  enema ; 
even  if  retained  for  some  time,  it  may  be  rejected  without 
apparent  change.  Under  the  most  favorable  circumstances, 
at  least  three-fourths  of  the  quantity  injected  will  come 
away  with  the  regular  evacuation  of  the  bowels.  The  amount 
of  energy  actually  supplied  must  be  far  below  the  theoretical 
demands  of  the  body.  In  some  cases,  it  is  of  course  possible 
to  nourish  the  patient  partly  by  the  mouth  and  partly  by 
rubbing  a  small  amount  of  fatty  matter  into  the  skin.  Some 
of  the  most  available  substances,  such  as  solutions  of  sugar^ 
are  naturally  irritating  to  the  rectum. 

It  is  possible  to  keep  a  patient  alive  for  weeks  and  even 
months  by  rectal  feeding,  but  in  many  cases  this  resource  for 
one  reason  or  another  fails  outright  to  do  what  is  expected  of 
it.  Hence  we  cannot  be  too  careful  as  to  technique  and 
choice  of  material  used.  Of  natural  substances,  milk  and 
eggs  have  been  very  freely  used.  The  albumin  and  sugar  in 
the  milk  are  probably  utilized.  In  an  emulsion  of  eggs,  the 
native  albumin  is  doubtless  the  constituent  which  nourishes 
the  patient.  We  cannot  be  sure  of  the  absorption  of  the 
fatty  matter  of  the  milk  and  eggs.  Both  these  substances  are 
relatively  non-irritating.  Peptonized  milk  answers  well  in 
some  cases.  It  is  best  to  carry  on  the  peptonization  for  a 
long  period,  until  the  end  products  of  digestion  form,  pep* 


FEEDING  THE  SICK 


81 


tones  themselves  being  often  irritating.  Solutions  of  glucose 
and  dextrin  are  useful,  alone  or  combined  with,  other  in- 
gredients. For  example,  eggs  may  be  combined  with  glucose, 
or  plain  milk  with  dextrin.  For  variety,  any  of  the  pre- 
digested  foods,  whether  these  come  in  solution  or  dried,  and 
even  bouillon  and  beef-tea  may  be  tried.  Starch  emulsion 
is  soothing  in  the  rectum  and  may  be  utilized  if  first  mixed 
wdth  diastase. 

The  technique  is  most  important.  The  rectum  should 
first  be  cleaned  by  a  high  injection  of  decinormal  saline 
solution,  after  which  no  attempt  should  be  made  to  give  a 
nourishing  injection  for  at  least  an  hour.  It  may  be  neces- 
sary for  the  physician  to  treat  the  rectum  if  hemorrhoids  or 
great  irritability  exists.  The  patient's  hips  should  be  raised 
higher  than  the  head  to  aid  in  retaining  the  enema.  A  tube 
specially  designed  for  the  purpose  should  be  used,  the  enema 
being  at  body  heat  and  allowed  to  flow  in  by  gravity  from 
a  funnel.  The  amount  injected  should  never  exceed  8  oz. 
and  the  enema  cannot  be  repeated  oftener  than  every  6 
hours  unless  the  quantity  is  small.  As  a  rule,  the  smaller  the 
enema  the  more  frequently  it  may  be  used.  After  an  injec- 
tion the  patient  should  be  kept  perfectly  quiet. 

Stimulants  like  black  coffee  and  whisky  are  often  given  by 
the  rectum,  the  whisky  requiring  dilution  with  two  parts 
water.  Wine  is  sometimes  used  for  the  purpose.  Stimulat- 
ing and  nutritive  enemata  may  be  combined. 

Injections  of  normal  salt  solution,  seltzer  water,  etc.,  are 
sometimes  used  to  supply  the  body  with  fluids  and  quench 
thirst. 

Useful  additions  to  enemata  comprise  a  little  salt  or  sodium 
bicarbonate  or  a  little  starch  emulsion;  at  times  a  few  drops 
of  laudanum  are  of  value  in  aiding  retention. 

One  should  not  be  discouraged  by  early  failure,  as  it  is 
possible  for  tolerance  to  be  established. 


83 


PRACTICAL  DIETETICS 


FORMULAE  FOR  RECTAL  FEEDING 

I.  Peptone-milk,  Von  Leube 

250  e.  e.  milk    =170  Cal. 

60  c.  c.  peptone   =100  Cal. 

II.  Egg-milk,  Von  Leube 

250  e.  c.  milk   =170  Cal. 

3  eggs   =200  CaL 

3  gms.  salt. 

III.  Starch-milk,  Von  Leube 

250  c.  c.  milk    =170  Cal. 

70  gms.  starch    =250  Cal. 

IV.  Sugar-milk,  Von  Leube 

250  c.  c.  milk   =170  Cal. 

50  gms.  grape  sugar    =  250  Cal. 

V.  Pancreas,  Von  Leube 

75  gm,  pancreas  substance    =  300  Cal. 

225  gm.  beef    =300  Cal. 

35  gms.  fat    =350  Cal. 

(This  enema,  in  semi-solid  condition,  is  introduced  into  the  rectum 
and  allowed  to  digest  therein.  A  piston  syringe  with  a  wide  nozzle 
is  required.) 

'Nutrient  Enema: 

Peptonised  Milk   5  S  ^'^  (four 

Whites  of  two  eggs   to  six  ounces) 

Above  used  Per  Rectum  every  two  to  four  hours. 

'Nutrient  Enema: 

Milk   5  ^  (^^^  ounce) 

German  Seltzer  ILO   3       (four  ounces) 

Used  in  Icterus,  every  two  hours. 

Nutrient  Enemata — Malted  Milk. 

Dissolve  from  three  to  four  heaping  teaspoonfuls  of  Horlick's 
malted  milk  powder  in  one-half  pint  of  water,  to  which  add  one-half 
teaspoonful  of  salt.  Use  at  body  temperature,  or  two  or  three  de- 
grees higher. 

The  white  of  one  egg  may  be  incorporated  if  desired. 

Four  to  six  ounces  used  per  rectum  every  two  to  four  hours. 

Stimulating  Enema: 

Black  Coffee   »  ^  iv  (four  ounces) 

Whiskey   3  "  (^^o  ounces > 


FEEDING  TEE  SICK 


83 


Salt  Solution: 

Sodium  chloride   3  i  (one  drachm) 

Aquae   O  i  (one  pint) 

Use  of  Alcohol  in  the  SicJc  Eoom.  The  nurse  may  be  re- 
quired to  exercise  her  own  judgment  at  times  in  the  emer- 
gency use  of  alcoholics  in  the  sick  room.  This  necessity  is 
most  likely  to  occur  with  those  patients  having  incurable 
maladies  where  the  question  of  harm  to  the  organism  or  to 
the  morals  of  the  individual  does  not  come  into  consideration. 
Consumptives  often  show  a  remarkable  tolerance  to  alcohol^ 
and  receive  a  notable  stimulating  effect  from  it^  and  it 
sometimes  happens  that  an  eggnog  or  milk  punch  will  enable 
an  advanced  consumptive  to  dress  and  make  his  toilet  in  the 
morning  when  otherwise  he  would  have  to  lie  in  bed.  This 
is  true  to  a  less  extent  of  some  other  incurable  diseases. 
Severe  acute  or  subacute  conditions  in  which  an  alcoholic 
stimulant  might  require  to  be  given  in  preference  to  any 
other  for  its  emergency  effect  in  averting  unlooked-for  cardiac 
failure  comprise  pyemia,  septicemia  and  diphtheria.  In  the 
same  class  belong  certain  cases  of  acute  poisoning  due  to 
mistakes  or  suicidal  intent,  such  as  those  due  to  aconite  and 
similar  heart  poisons.  The  propriety  of  giving  alcoholics 
after  simple  collapse  or  syncope  when  no  serious  disease  is 
present  depends  upon  the  nature  of  the  case  and  whether 
other  stimulants  are  available. 

Alcohol  should  perhaps  never  be  given  even  in  emergencies 
to  subjects  with  neurosis  or  insanity  or  to  victims  of  severe 
disease  of  the  gastrointestinal  organs. 

Keeping  Ice  in  the  Side  Room.  The  very  best  plan  is  to 
have  a  small  refrigerator  or  a  Japanese  ice  box,  which  may 
be  had  for  a  few  dollars.  If  these  little  luxuries  are  im- 
possible, put  the  ice  in  a  deep  bowl,  cover  it  with  a  plate, 
and  place  the  bowl  between  two  clean  feather  pillows.  An- 
other simple  way  of  keeping  ice  is  to  put  it  in  a  dish  pan, 
cover  with  a  tin  lid,  and  wrap  in  flannel  cloths  and  news- 
papers. It  will  keep  a  long  time,  as  feathers,  wool  and 
paper  are  poor  conductors  of  heat. 


84 


PRACTICAL  DIETETICS 


Disinfecting  Utensils.  All  dishes  or  utensils  used  in  the 
sick  room  should  be  disinfected  before  being  sent  to  the 
kitchen  to  be  washed.  A  simple  method  is  to  scrape  them 
clean  and  dip  them  in  a  basin  of  borax  water  (a  teaspoonful 
of  borax  in  a  shallow  bowl  of  water).  In  case  of  infectious 
diseases  all  dishes  and  utensils  should  be  boiled  in  water 
containing  3  per  cent,  of  sodium  bicarbonate  for  one-half  an 
hour  to  one  hour. 


CHAPTER  Y 


THE  TRAY 

The  writer's  intention  is  only  to  suggest  to  the  nurse  the 
best  and  simplest  methods  of  arranging  the  tray  and  a  few 
of  the  important  details. 

These  things  seem  trivial,  but  it  must  be  remembered  that 
the  horizon  of  the  sick  room  is  limited,  and  that  the  patient 
who  has  long  been  confined  to  bed  with  a  serious  illness  thinks 
much  of  his  immediate  surroundings. 

He  may  seem  too  ill  to  notice  these  details,  whereas  he  is 
only  too  ill  to  speak  of  them,  for  one  feeds  with  the  eyes  quite 
as  much  as  with  the  lips,  and  by  some  carelessness  of  the 
nurse  the  appetite  of  a  refined,  fastidious,  or  nervous  pa- 
tient may  be  wholly  destroyed. 

While  the  natural  stimulants  to  appetite,  such  as  fresh 
air,  exercise  and  enlivening  companionship,  are  necessarily 
wanting,  the  taking  of  food  is  the  chief  event  of  the  day,, 
and  too  much  care  cannot  be  bestowed  upon  its  preparation 
and  service,  as,  has  been  said,  the  appearance  and  manner  of 
offering  have  much  to  do  with  its  acceptance  or  rejection. 

ATTRACTIVE  ARRANGEMENT  OE  A  TRAY 

The  cover  and  the  arrangement  of  the  tray  is  of  the  ut- 
most importance,  and  the  slightest  departure  from  regularity 
and  immaculate  cleanliness  should  be  avoided. 

The  tray  should  be  covered  with  fine  linen  damask,  with* 
out  crease  or  wrinkle  —  the  best  you  can  afford.  Use  the 
choicest  silver,  daintiest  china  and  glassware ;  arrange  neatly 
and  conveniently.  Place  a  single  rose  or  flower  on  the  tray; 
a  quotation,  added  as  a  variety,  will  often  attract  the  atten- 
tion, and  it  is  well,  when  possible,  to  divert  the  patient^s 
85 


.86 


PRACTICAL  DIETETICS 


mind  from  his  ailments  while  eating.  This  can  easily  be 
done  in  these  little  ways,  and  also  by  the  introduction  of 
;some  cheerful  and  interesting  topic  of  conversation. 


Proper  Placing 


1  Plate. 

2  Cup  and  saucer. 

3  Bread  and  butter  plate. 

4  Individual  creamer  and  sugar. 

5  Tumbler. 

6  Individual  salt. 


7  Knife. 

8  Fork. 

9  Spoon. 

10  Butter  spread. 

11  Napkin. 

12  Flowers. 


13  Salad  knife.  17  After  coffee  spoon. 

14  Soup  spoon.  18  Soup  or  cereal  or  berry  plate, 

15  Oyster  fork.  etc. 

16  Salad  fork. 

N.B. —  The  dots  between  numbers  7  and  2  reading  from  left  to 
right  represent  numbers  13,  14,  15,  and  17.  Sharp  edge  of  knife 
turned  toward  plate;  tines  of  forks,  bowl  of  spoons,  all  dishes  and 
tumblers  placed  right  side  up. 


How  to  Serve.  (General  Eules.)  The  time  of  cooking 
food  to  be  served,  should  be  carefully  considered  in  relation 


TEE  TRAY 


87 


to  the  time  of  serving,  for  most  palatable  food  may  be 
spoiled  by  not  serving  it  at  the  proper  time. 

Avoid  serving  too  many  things  on  tray.  Cover  tray  with  a 
clean  napkin  or  tray  cover  in  carrying  it  to  its  destination. 
WTien  the  dietary  ordered  is  very  limited  in  variety,  the  pa- 
tient is  often  gratified  by  having  his  food  served  in  courses, 
and  will  eat  more  than  if  given  everything  at  once. 

Only  a  small  quantity  should  be  served  at  one  time.  If 
possible,  taste  of  all  food  and  drinks  before  serving,  to  see 
if  properly  seasoned  and  at  right  temperature  to  serve. 

Always  use  separate  spoon  for  tasting. 

rood  to  be  served  hot,  should  be  served  liot  (not  luke- 
warm), in  heated  dishes  and  covered  in  transit. 

Cold  drinks  and  fruits  are  more  healthful  when  served 
cool  than  ice-cold. 

When  fluid  foods  are  to  be  given,  other  receptacles  should 
be  used  than  those  used  for  medicine,  or  the  association  of 
ideas  may  be  strong  enough  to  destroy  what  little  appetite 
the  patient  has,  and  to  even  produce  nausea.  Do  not  fill 
cups  or  glasses  full,  but  within  one  inch  of  the  top.  For 
individual  dishes,  for  a  luncheon,  or  drinks  to  be  passed 
alone,  use  a  small  tray  or  plate,  covered  with  a  doily  or 
folded  napkin. 

The  finger-bowl  should  be  placed  on  a  small  plate,  cov- 
ered with  a  dainty  doily;  fill  one-fourth  full  of  water,  and 
put  a  few  rose  petals  or  green  leaves  in  the  water  and  on  the 
side  of  the  plate. 

When  possible,  cover  all  foods  and  drinks  left  standing  in 
the  sick  room. 

The  tray  and  all  traces  of  a  meal  should  be  removed  im- 
mediately after  eating.  Half-emptied  cups  or  glasses  should 
never  be  left  in  the  room. 

If  the  patient  is  restricted  to  any  especial  diet,  vary  as 
far  as  possible  in  the  preparation  and  serving. 

The  diet  of  the  patient  should  be  under  the  supervision 
of  the  physician,  and  his  directions  followed  implicitly,  for 
much  unnecessary  suffering,  and  even  death,  has  been  the 
result  of  giving  forbidden  food. 


CHAPTER  VI 


METHODS  OF  COOKING  AND  CARE  OF  FOOD 

Cooking  is  the  preparation  of  food  for  eating. 

Digestibility  and  Nutritive  Value  of  cooked  food  depends 
to  a  considerable  extent  upon  the  manner  in  which  it  is 
cooked  and  served.  The  time  and  temperature  of  cooking 
should  be  carefully  considered,  in  relation  to  the  constituents 
of  the  food  material. 

Success  in  Cooking  depends  in  part  upon  the  quality  of 
material  used,  which  should  be  the  best.  The  measurements 
must  be  accurate.  Care  should  be  exercised  in  combining 
ingredients  and  one  should  know  the  effect  of  various  modes 
of  cooking  on  the  food  under  consideration.  Training  and 
experience  are  necessary  for  success. 

Objective  Points  in  Cooking : 

1.  To  improve  the  flavor  of  food,  or  render  it  more  pal- 
atable. 

2.  To  soften  it  that  it  may  be  more  readily  masticated  and 
digested. 

3.  To  produce  chemical  changes  which  increase  digestibil- 
ity. 

4.  To  destroy  bacteria  and  parasites  which  may  be  pres- 
ent in  raw  food. 

Effects  of  Heat,  Protein  is  coagulated  by  hot  water  and 
dry  heat ;  cold  water  dissolves  soluble  proteins,  especially  if  a 
little  salt  is  present. 

Starch  is  converted  into  dextrin  by  dry  heat  at  a  tempera- 
ture of  320°  F. ;  the  starch  granules  dissolve  when  subjected 
to  boiling  water;  cold  water  separates  starch  grains. 

88 


METHODS  OF  COOKING  AND  CARE  OF  FOOD  89 


Sugars  are  changed  to  caramel  at  a  high  temperature. 

Fats  are  readily  decomposed  by  heat,  with  production  of 
free  fatty  acids. 

Principles  Governing  the  Choice  of  a  Method  of  Coohing 
Any  Food.  These  include:  (1)  A  knowledge  of  the  effects 
of  heat  and  moisture  on  the  digestibility  of  the  articles  to  be 
cooked.  (2)  The  relation  of  the  method  to  the  extraction  of 
soluble  portions  of  the  food  materials. 

Principal  Cooking  Processes: 

1.  Boiling  is  cooking  in  boiling  water  (212°  F.).  Gentle 
boiling  is  as  effective  as  rapid,  and  prevents  waste  of  fuel  if 
gas  is  used. 

2.  Stewing  is  long,  slow  cooking  in  water  below  the  boil- 
ing point— 186°  F. 

3.  Steaming  is  cooking  in  heat  derived  from  the  vapor  of 
boiling  water.  It  is  of  two  types.  (1)  In  a  steamer  (moist 
heat).    (2)  In  a  double  boiler  (dry  heat). 

4.  Broiling  is  cooking  over  a  glowing  fire  or  over  or  un- 
der a  flame.  Pan  broiling  is  cooking  meat  in  a  very  hot 
frying-pan  without  fat,  turning  the  meat  often. 

5.  Baking  is  cooking  in  an  oven  by  means  of  heated  air. 
Eoasting  is  cooking  before  a  glowing  fire  (direct  heat). 

6.  Frying  is  cooking  in  a  deep  bath  of  hot  fat  (tempera- 
ture ranging  from  350°  to  400°  F.). 

Other  methods  are  used  which  differ  but  slightly  from  the 
above.  Braizing  is  a  combination  of  stewing  and  baking; 
fricasseeing  of  frying  and  stewing. 

The  Object  of  Each  Cooking  Process: 

1.  To  retain  the  juice  as  in  boiling,  steaming,  broiling^  bak- 
ing, roasting,  frying. 

2.  To  extract  the  juices  as  in  soups. 

3.  Partly  to  retain  and  partly  to  extract  the  juices  as  in 
stews,  chowders,  braising,  and  fricasseeing. 

Cooking  Utensils.  A  nurse  should  always  have  at  hand  a 
standard  m.easuring  cup,  divided  into  thirds  and  fourths. 
Wooden  spoons  are  preferable  to  metal  ones  for  mixing  and 


90 


PRACTICAL  DIETETICS 


stirrings  as  metal  spoons  are  too  hard  and  may  break  off 
bits  of  enamel^  and  are  also  acted  upon  by  acids.  For  beating 
egg-white^  a  spoon-shaped  wire  beater  should  be  used;  for 
the  yolks,  a  fork  or  Dover  egg  beater  is  preferable.  Use 
round  bottom  utensils  when  stirring  is  necessary  during  the 
cooking.  Use  earthen  bowl  and  wooden  spoons  for  mixing 
batters,  etc.  A  double  boiler  should  be  used  when  cooking 
any  food  that  burns  easily  (as  milk) ;  also  when  foods  are  to 
be  cooked  at  low  temperatures. 

Blending  Ingredients,  There  are  several  ways  of  accom- 
plishing this  purpose. 

1.  Stirring.  This  is  simple  mechanical  mixing  in  which 
a  mass  of  ingredients  is  made  uniform. 

2.  Beating  or  whipping  consists  in  so  manipulating  a  soft 
mixture  as  to  incorporate  the  air.  A  spoon  or  special  device 
is  so  applied  that  the  bottom  of  the  mixture  is  steadily  lifted 
to  the  top. 

3.  Folding-in  is  a  term  applied  to  the  method  of  intro- 
ducing beaten  white  of  egg  slowly  and  gently  into  a  soft 
mass,  so  as  to  render  it  light,  the  air  being  retained. 

4.  Cutting  is  used  only  in  making  pastry.  Two  knives  are 
worked  in  opposite  directions  until  the  shortening  is  well 
incorporated  in  the  flour. 

Suggestions  as  to  Methods  of  WorTcing.  If  a  fire  and  oven 
are  to  be  used  these  must  be  first  of  all  attended  to  that  they 
he  in  readiness  when  needed.  All  the  cooking  apparatus 
should  be  laid  out  and  the  materials  to  be  cooked  measured 
in  preparations  for  mixing.  It  is  advisable  to  be  economical 
in  the  use  of  utensils.  Thus  one  measuring  cup  may  some- 
times be  used  in  succession  for  dry  materials,  liquids  and 
fats,  in  the  order  named.  A  receptacle  should  be  at  hand 
for  soiled  spoons  and  other  utensils  employed  in  measuring 
or  mixing.  It  is  desirable  to  work  as  much  as  possible  in  a 
small  space;  thus  the  measuring  and  mixing  should  be  done 
on  a  single  table  if  possible.  All  soiled  dishes  should  be  put 
to  soak ;  at  odd  moments  they  may  be  washed,  dried  and  put 
away.    The  purpose  underlying  these  principles  is  that  the 


METHODS  OF  COOKING  AND  CARE  OF  FOOD  91 


nurse  may  go  into  the  family  kitchen  and  prepare  food  for 
the  patient  without  in  the  least  interfering  with  the  regular 
titchen  work  of  the  household. 

Ice  Box  and  Contents,  The  ice  box  should  be  maintained 
in  a  state  of  absolute  cleanliness.  This  is  not  difficult  in 
the  case  of  a  simple  portable  refrigerator  without  a  drain 
pipe,  which  may  be  flushed  out  daily  with  boiling  water  con- 
taining borax  or  ammonia  (half  ounce  to  the  gallon).  How- 
ever, in  the  larger  kinds  of  portable  refrigerators,  and  in  the 
set  ice  boxes  where  a  tube  is  necessary  for  drainage,  all  the 
compartments  and  shelves  should  be  washed  with  soap  and 
hot  water  at  least  once  in  a  week,  while  every  day  loose  par- 
ticles of  food  which  have  escaped  from  dishes,  etc.,  should 
be  carefully  removed ;  or  if  advisable  in  certain  cases,  the  food 
-and  shelves  may  be  removed  and  wiped  or  brushed  off.  The 
drainage  pipes  must  be  cleaned  with  a  brush  made  for  the 
purpose  at  least  once  a  week.  It  is  advisable  to  sprinkle 
borax  on  the  shelves  after  cleaning.  Certain  pungent  articles 
can  not  be  kept  in  an  ice  box  without  flavoring  other  foods 
such  as  butter,  milk,  etc. 

Institutions,  if  large  enough,  may  use  a  refrigerating  plant, 
which  does  away  in  part  with  the  handling  of  ice;  or  by  the 
aid  of  an  ice  machine,  superintendents  may  assure  them- 
selves of  the  purity  of  all  ice  designed  for  internal  use. 

The  drain  pipe  of  an  ice  box  should  not,  for  obvious  rea- 
sons, communicate  with  the  sewerage  system. 

The  temperature  in  the  food  compartments  is  sometimes 
much  warmer  than  one  would  imagine;  and  it  is  desirable 
to  get  some  idea  of  what  the  temperature  fluctuations  are  by 
using  a  thermometer.  The  reading  can  hardly  go  lower  than 
40°  F.  and  should  not  be  over  60°  P. 

The  ice  cake  should  be  wrapped  in  cloth  or  paper,  not  only 
for  economy's  sake  but  because  it  may  be  dirty  inside  or  out- 
side. No  food  should  be  placed  in  the  box  while  warm,  for 
the  sudden  cooling  may  set  up  undesirable  changes.  Canned 
food  should  not  be  placed  on  ice  in  the  opened  can,  but  in  a 
fresh  receptacle.    When  possible,  each  article  should  be 


92 


PRACTICAL  DIETETICS 


placed  in  a  separate  container^  or  wrapped  in  paper.  Mois- 
ture in  the  ice  box,  while  unavoidable,  should  be  kept  down 
by  wiping  walls  and  shelves  dry  at  intervals. 

CARE  OF  FOODi 

The  care  of  food  between  the  time  of  purchase  and  cooking, 
and  that  of  cooking  and  serving  is  highly  important.  The 
fact  that  spoiled  food  represents  an  economic  loss,  important 
as  it  is,  is  much  less  significant  than  the  fact  that  not  only 
spoiled  food,  but  good  food  which  is  contaminated  with  germ 
life,  is  a  possible  source  of  disease. 

Exposed  food,  i.  e.,  food  exposed  to  dust,  insects,  etc.,  be- 
comes contaminated  with  disease  germs  without  necessarily 
becoming  spoiled  or  in  any  way  offensive  to  the  senses.  The 
most  crisp  salad  or  luscious  fruit  may  be  covered  with  dan- 
gerous microorganisms. 

By  far  the  most  frequent  and  abundant  forms  of  micro- 
organisms, which  grow  at  such  rate  as  quickly  to  become  vis- 
ible to  the  naked  eye,  are  molds.  These  are  not  on  the  whole 
harmful  to  man,  and  their  chief  significance  is  that  they  give 
to  foods  a  bad  flavor  and  cause  a  certain  amount  of  decompo- 
sition. These  organisms  attack  food  which  is  stored  in  dark, 
damp  places,  chiefly  cellars,  and  although  themselves  gen- 
erally harmless,  they  are  likely  to  be  associated  with  poisonous 
bacteria.  Certain  butchers  hang  steaks  until  they  become 
covered  with  mold,  but  the  mold  does  not  make  the  meat  ten- 
der and  highly  flavored,  for  these  changes  are  due  largely 
to  the  bacteria  of  putrefaction  which  are  also  present,  thriv- 
ing under  the  same  conditions  as  does  the  mold. 

In  case  of  substances  which  have  a  natural  protective  cov- 
ering, it  is  highly  important  that  this  should  not  be  broken 
in  handling.  Thus  when  fruits  and  vegetables  are  bruised, 
the  pulp  is  quickly  attacked  by  microorganisms  and  local 
changes  occur,  resulting  in  economic  waste,  since  such  articles 
can  only  be  partly  utilized. 

^  For  further  information,  note  "  Care  of  Food  in  the  Home."  Farmers' 
Bulletin,  No.  375  U.  S.  Dept.  of  Agriculture,  Washington,  D.  C. 


METHODS  OF  COOKING  AND  CARE  OF  FOOD  93 


Foods  should  therefore  be  stored  in  places  which  admit 
plenty  of  sunlight  and  air,  which  will  antagonize  the  growth 
of  molds  and  putrefactive  bacteria.  Ice,  by  producing  tem- 
peratures unfavorable  for  the  growth  of  microorganisms,  is 
a  valuable  aid  in  this  sort  of  cleanliness.  Some  use  of  soap 
and  water  is  necessary,  but  the  benefits  are  partly  lost  if  the 
shelves,  etc.,  are  left  damp.  In  cellars  repeated  whitewashing 
is  the  most  available  resource  for  cleanliness. 

Food  should  be  bought  in  the  freshest  and  cleanest  state, 
should  be  placed  in  clean  ,  containers,  and  handled  with  clean 
hands.  Foods  should  always  be  washed  if  there  is  any  suspi- 
cion of  contamination.  The  cases  of  violent  cholera  morbus 
which  often  follow  the  use  of  unripe  apples,  and  even  of  ripe 
fruit  like  cherries,  are  believed  to  be  due  not  to  the  irritating 
acids  present  in  fruit,  but  to  the  presence  of  a  well-known 
bacterium  mingled  with  the  dust  which  collects  on  such  fruit. 
To  be  absolutely  on  the  safe  side,  all  fruits  and  vegetables 
should  be  eaten  cooked,  but  this  would  deprive  us  of  salads 
and  fresh  fruits  and  berries  which  form  so  large  and  pleas- 
urable a  part  of  the  average  dietary.  It  has  been  found  by 
experience  that  if  celery,  greens,  asparagus,  berries,  etc.,  are 
washed  repeatedly  in  cool  or  tepid  water,  they  can  at  last 
become  quite  clean  without  losing  their  delicate  flavor  and 
consistency.  As  long  as  a  particle  of  grit  is  present  there  is 
of  course  possibility  of  contamination  by  living  organisms. 
They  should  be  washed,  therefore,  until  the  wash  water  is 
clear.  This  is  a  rule  which  applies  to  all  food  that  is  to 
be  eaten  raw.  With  cooking  such  caution  is  not  absolutely 
necessary.  Potatoes,  etc.,  are  washed  before  boiling  for 
esthetic  reasons  only. 

The  worst  cases  of  food  poisoning,  known  as  ptomaine 
poisoning,  are  mysterious  in  character,  and  are  not  entirely 
preventable.  Chemical  substances  not  usually  formed  in  sim- 
ple decomposition  are  responsible.  They  may  be  present  alike 
in  raw,  cooked,  or  frozen  foods,  and  in  fresh  and  preserved 
foods.  In  some  cases  there  is  abundant  evidence  of  extreme 
decomposition.    The  use  of  rotten  eggs  in  cookery  by  bakers 


94 


PRACTICAL  DIETETICS 


has  caused  severe  ptomaine  poisoning.  Cold  storage  meats 
are  sometimes  responsible.  Fish  poisonings  especially  with 
shell  fish^  may  be  due  to  some  unknown  disease  of  the  ani- 
mals themselves  (although  fish  very  readily  undergo  decom- 
position), and  personal  susceptibility  is  often  a  factor.  The 
numerous  cases  of  ice  cream  poisoning  are  usually  due  to 
mistakes  of  amateurs  who  do  not  understand  the  proper  re- 
quirements of  the  art.  Although  we  do  not  understand  and 
cannot  always  foresee  ptomaine  poisoning,  it  is  the  more 
important  that  no  step  be  neglected  which  will  contribute  in 
theory  to  securing  clean  food.  Most  cases  occur  in  prolonged 
warm  weather  in  which  decomposition  is  favored.  Sounds 
fresh  food,  thoroughly  cooked  and  eaten  at  once  could  hardly 
cause  ptomaine  poisoning  under  any  conditions. 

The  articles  which  the  ordinary  careful  nurse  must  think 
of  in  this  connection  are  preserved  foods  of  all  kinds,  shell 
fish,  and  milk  products,  the  latter  being  of  most  significance, 
because  milk,  fresh  cream,  ice  cream,  etc.,  are  often  given 
freely  to  invalids.  The  care  of  milk,  drinking  water  and 
other  kinds  of  food  is  considered  elsewhere. 

Special  care  of  food  in  respect  to  fiy  pollution  has  become 
necessary  since  we  have  learned  of  the  part  played  by  this 
insect  in  causing  typhoid  fever,  cholera,  dysentery,  etc.  Both 
the  feet  and  the  excrement  of  flies  are  sources  of  contamina- 
tion. Dealers  in  food-stuffs  in  the  main  take  but  little  pains 
against  protecting  their  wares  from  fiy  contamination.  Cook- 
ing and  careful  washing  of  food  to  be  eaten  raw,  are  our 
principal  safeguards  in  respect  to  food  as  it  reaches  the  house- 
There  is  the  added  danger  that  food  when  ready  for  con- 
sumption will  be  freshly  contaminated.  To  obviate  this,, 
doors  and  windows  of  kitchens  and  dining  rooms  must  be 
properly  screened,  and  fiypaper  and  similar  precautions  em- 
ployed. If  typhoid  is  epidemic  in  a  neighborhood,  it  is  well 
to  avoid  raw  food  entirely,  just  as  we  avoid  unsterilized  water 
and  milk.  Flies  are  much  more  likely  to  abound  in  neighbor- 
hoods where  manure,  garbage,  etc.,  are  allowed  to  accumulate,, 
and  are  more  dangerous  than  ordinary  dust. 


METHODS  OF  COOKING  AND  CARE  OF  FOOD  95 


Dealers  usually  are  at  some  pains  to  keep  their  supplies  free 
from  dust^  though  their  methods  are  not  always  sanitary, 
e.  g.,  the  use  of  the  feather  duster  for  fruit.  Dust  from  the 
streets  of  cities  abounds  in  germ  life.  Vegetables  and  cer- 
tain fruits  in  clusters  which  cannot  be  wiped  (grapes,  cur- 
rants, etc.)  are  most  likely  to  be  dusty.  Washing  succes- 
sively in  a  number  of  waters  will  usually  remove  the  dust; 
but  in  the  tropics  where  many  diseases  are  dust-borne  it  is  not 
considered  safe  to  eat  raw  grapes  at  all.  "Wliether  washing 
is  sufficient  depends  on  the  character  of  the  dust  and  the 
degree  of  exposure  to  it. 

Preserving  Foods,  Foods  to  be  preserved  should  be  per- 
fectly fresh.    Yeo  gives  four  methods  of  preservation: 

(1)  Drying  is  the  method  most  available  for  preserving 
peas,  beans,  prunes,  apricots  and  other  fruits.  Milk  and  eggs 
may  both  be  preserved  by  desiccation. 

(2)  Exclusion  of  air  may  be  applied  in  several  ways. 
Smoking,  which  coagulates  the  outer  surface  and  sterilizes 
it,  serves  for  preserving  ham,  bacon,  fish,  etc.  Packing  in 
sawdust,  etc.,  or  dipping  in  wax  preserves  eggs.  Canning  in 
tins  or  jars  under  steam  heat  is  used  for  preserving  many 
kinds  of  food,  all  air  thus  being  forced  out  before  the  can  or 
jar  is  hermetically  sealed. 

(3)  Freezing  and  cold  storage  are  used  extensively  for 
preserving  fish,  meat,  jams,  etc.  Such  foods  must  be  cooked 
immediately  upon  thawing. 

(4)  Antiseptics  are  used  very  extensively  in  food  preserva- 
tion. The  oldest  and  most  widely  known  of  these  are  salt, 
vinegar,  alcohol  and  syrups.  More  recently  a  great  variety 
of  antiseptic  chemicals  have  been  used  —  benzoate  of  soda, 
salicylic  acid,  etc.,  etc.  The  advisability  of  their  use,  even 
in  minute  quantities,  is  questionable. 

Concentration,  Most  foods  can  be  reduced  to  a  dry  or 
otherwise  condensed  state  without  loss  of  nutritive  value  or 
danger  of  decomposition;  and  on  account  of  the  resulting 
economy  in  price  and  storage  room  may  enter  into  the  dietaries 
of  hospitals  and  institutions.    Sugar,  oil  and  starch,  and 


96 


PRACTICAL  DIETETICS 


many  cereal  products,  are  already  in  a  state  of  concentration. 
Powdered  milk  and  meat,  egg  powder,  etc.,  are  coming  more 
and  more  into  use.  Condensed  milk  has  long  been  a  useful 
product  (see  milk  and  milk  preparations),  as  have  dried  and 
evaporated  fruits  and  vegetables.  All  these  products  can  be 
used  in  cookery.  Their  chief  use  as  mainstays  will  doubtless 
be  in  cases  of  temporary  shortage  of  fresh  foods,  due  to 
devastating  storms,  strikes  and  other  happenings  which 
interrupt  traffic. 

Predigestion  of  Food,  Much  is  written  against  the  use  of 
predigested  foods  as  a  steady  diet  for  the  well.  Many  starchy 
foods  on  the  market  are  partially  digested  by  heat.  The 
objection  seems  to  rest  on  the  theory  that  such  foods  give  the 
digestive  fluids  and  muscles  of  the  digestive  organs  nothing 
to  do,  and  that  a  sort  of  sluggishness  is  set  up.  It  cannot 
be  said  truthfully  that  these  claims  have  ever  been  backed 
up  by  facts.  No  one  denies  that  thorough  mastication  is  a 
great  advantage,  and  with  thorough  mastication  much  of  the 
starch  is  predigested  in  the  mouth,  or,  after  swallowing,  in 
the  fundus  of  the  stomach.  Predigested  proteins  are  not  used 
as  staple  foods,  and  as  little  is  gained  by  very  finely  masti- 
cating flesh  foods,  the  stomach  has  plenty  of  work  in  digest- 
ing animal  proteins.  If  there  is  fat  in  the  diet  the  pancreas 
can  never  fall  into  a  state  of  disuse.  Hence  the  outcry 
against  partially  predigested  breakfast  foods  does  not  seem 
justified  on  this  score.  It  is  true,  however,  that  their  absence 
of  flavor,  and  the  soft  and  pulpy  character  of  some  of  them 
are  recognized  as  possible  drawbacks;  for  semi-solid  and 
pultaceous  foods  are  difficult  to  masticate,  while  their  in- 
sipidity does  not  flavor  a  flow  of  digestive  fluids.  If  ad- 
herence to  these  foods  causes  sluggish  digestion  and  inability 
to  deal  with  food  in  more  natural  condition,  one  would  impute 
this  not  to  predigestion,  but  to  the  fact  that  the  tastelessness 
and  the  ease  with  which  they  may  be  bolted,  are  the  real 
factors  which  bring  about  a  passive  state  of  the  digestive 
functions. 


METHODS  OF  COOKING  AND  CARE  OF  FOOD  97 


In  a  diet  for  the  ill,  the  dyspeptic,  the  convalescent,  etc., 
there  can  be  no  possible  objection  to  predigestion ;  on  the  con- 
trary, it  is  highly  desirable  up  to  a  certain  extent.  But  just 
as  soon  as  possible  the  patient  should  return  to  foods  in  the 
natural  state,  bearing  in  mind  that  a  small  minority  of 
cases,  even  the  acutely  ill,  thrive  on  food  which  in  theory 
would  be  hazardous  to  say  the  least.  Apparently  hopeless 
cases  of  sepsis  have  seemingly  been  rescued  by  placing  pa- 
tients on  food  suited  only  for  the  healthy.  Such  patients 
must,  however,  have  a  natural  appetite  and  be  able  to  tolerate 
the  food. 

Adulteration  of  Food.  "  Since  the  passage  of  the  National 
Pure  Food  and  Drugs  Act,  giving  to  the  United  States  Gov- 
ernment authority  to  enforce  stringent  laws  against  the  adul- 
teration and  misbranding  of  foods  which  enter  into  inter- 
state commerce,  and  the  more  rigid  enforcement  of  similar 
state  laws  which  regulate  these  matters  in  many  of  the  states, 
a  great  burden  has  been  lifted  from  the  shoulders  of  the  buyer. 
This  legislation  has  enormously  decreased  the  deceptions 
formerly  practiced  by  some  manufacturers,  and  since  it  in- 
sures that  the  name  and  description  on  bottle  and  package 
shall  not  misrepresent  the  contents,  the  buyer,  if  he  knows 
what  he  wants,  will  have  no  difficulty  in  obtaining  it,  while 
the  honest  manufacturers  and  dealers  (and  they  have  with- 
out doubt  always  outnumbered  the  others)  will  also  be  pro- 
tected. This  matter  in  its  various  aspects  is  taken  up  in 
publications  of  the  Bureau  of  Chemistry  ^  of  this  Depart- 
ment.^^ ^  For  Table  of  Common  Adulteration  of  Food- 
stuffs, note  Farmer's  Bulletin  No.  25,  of  the  United  States 
Department  of  Agriculture,  Division  of  Chemistry,  Washing- 
ton, D.  C. 

1 U.  S.  Dept.  Agriculture  Bureau  of  Chemistry,  Bulletin  100:  Year  Book 
1907,  p.  321. 

2  U.  S.  Dept.  Agriculture,  Bureau  of  Chemistry,  Bulletin  325,  p.  19. 


CHAPTEE  VII 


MEASURES  AND  WEIGHTS 


Accurate  measurement  is  •  necessary  to  insure  success  in 
cooking. 

All  dry  ingredients,  such  as  flour^  meal,  confectioners'  or 
powdered  sugar,  should  be  sifted  before  measuring. 

Mustard,  cream  of  tartar,  soda,  and  salt  should  be  stirred 
before  measuring,  to  lighten  and  free  from  lumps. 


A  standard  measuring  cup  contains  one-lialf  pint  and  is 
divided  into  fourths  and  thirds. 

To  measure  a  cupful  of  dry  material,  put  in  the  ingredients 
by  spoonfuls,  round  slightly  and  level  with  back  of  case- 
knife,  being  careful  not  to  shake  cup. 

A  cupful  is  measured  level  with  the  brim. 

A  heaping  cupful  is  measured  level,  w^ith  two  table  spoon- 
fuls extra  added. 

A  scant  cupful  is  measured  level,  with  two  table  spoonfuls 
taken  out. 

All  ingredients  measured  hy  the  tablespoon  or  teaspoon  are 
measured  leveL 


A  Standard  Measuring  Cnp 


98 


MEASURES  AND  WEIGHTS  99 


To  measure  a  spoonful,  fill  the  spoon  and  level  it  off  with 
the  back  of  case-knife. 


To  measure  a  half-spoonful^  first  measure  a  spoonful  and 
then  cut  it  in  halves,  lengthwise. 

To  measure  a  quarter-spoonful,  measure  a  half-spoonful 
and  divide  it  into  half,  crosswise,  allowing  a  little  more  for 
tip  of  spoon. 

A  saltspoon  is  one-fourth  of  a  level  teaspoon. 

A  speck  is  a  little  less  than  one-eighth  of  a  teaspoon. 

To  measure  butter,  lard,  and  other  solid  fats,  pack  solidly 
into  spoon  or  cup  and  level  with  knife. 

When  recipe  calls  for  one  tablespoon  (or  so)  of  iutter 
melted,  measure  before  melting.  When  recipe  calls  for  one 
tablespoon  (or  so)  of  melted  butter,  measure  after  melting. 

TABLE  OF  MEASTJRES  ANP  WEIGHTS 

4  saltspoons    =  1  teaspoon,  tsp. 

3  teaspoons    =  1  tablespoon,  tbsp. 

4  tablespoons    =  i  cup  or  i  gill. 

16  tablespoons   (dry  ingredients)  . . .  o » c . . » ,  =1  cup,  c. 

16  tablespoons  (liquid)   =1  cup. 


100 


PRACTICAL  DIETETICS 


2  gills   c  

rrz  1 

cup. 

2  cups  .    

pint. 

2  pints   

=  1 

quart. 

4  quarts   

__  I 

gallon. 

2  tablespoons  butter   

Y 

ounce. 

1  tablespoon  melted,  butter 

=1  1 

ounce. 

4  tablespoons  flour 

=  1 

ounce. 

2  tablespoons  granulated,  sugar  . . 

=:  1 

ounce. 

2  tablespoons  li(juid   

ounce. 

2  tablespoons  powdered,  lime 

=z  1 

ounce. 

1  cup  of  stale  bread  crumbs  •  

=  2 

ounces. 

1  square  Baker's  unsweetened  chocolate  .... 

=  1 

ounce. 

Juice  of  one  lemon  =  ( about )  3  tablespoons. .  . 

5  table  spoons  liquid   

=  1 

wineglassful# 

4  cups  of  sifted  flour  

—  1 

pound. 

2  cups  of  butter  (packed,  solid) 

=:  1 

pound. 

2  cups  of  finely  chopped  meat  (packed  solidly) 

r=  1 

pound. 

2  cups  of  granulated  sugar 

—  1 

pound. 

2§  cups  of  powdered  sugar   

pound. 

pound. 

=  1 

pound. 

pound. 

pound. 

=  i 

pound. 

APOTHECARIES  WEIGHTS 

20  grains    =  1  scruple,  3] 

3  scruples    =1  drachm,  5 

8  drachms  (or  480  grains)    =1  ounce,  5 

12  ounces    =  1  pound,  lb. 


APOTHECARIES  MEASURES 

60  minims  (M)    =  1  fluid  drachm,  f3 

8  fluid  drachms    =  1  fluid  ounce,  f3 

16  fluid  ounces    =1  pint,  0  or  pt. 

2  pints    z=  1  quart,  qt. 

4  quarts    =  1  gallon,  gal. 

APPROXIMATE  MEASURES 

One  teaspoonful    equals  about  1  fluid  drachm. 

One  dessertspoonful    equals  about  2  fluid  drachms. 

One  tablespoonful   equals  about  4  fluid  drachms. 

One  wineglassful    equals  about  2  ounces. 

One  cup  (one-half  pint)    equals  about  8  ounces. 


MEASURES  AND  WEIGHTS  101 


METRIC  SYSTEM 

For  the  origin  and  underlying  principles  of  the  metric 
system  consult  any  modern  arithmetic  (Milne's  Standard,  for 
example).  The  nurse  should  know  the  metric  tables  and  the 
equivalents  between  the  metric  and  common  systems  for  meas- 
ures of  volume  and  weight.  She  does  not  require  linear  and 
square  measure,  nor  measures  of  capacity  except  in  a  few 
instances. 

The  subjoined  tables  and  equivalents  will  suffice. 

TABLES 
Measures  of  Volume 

In  measuring  small  quantities  the  cubic  centimeter  is  the 
unit. 

1  cubic  centimeter   

10  cubic  centimeters   

1  cubic  millimeter   

1-100  cubic  millimeter   

1-1000  cubic  centimeter   

etc.,  etc 

MEASURES  OF  WEIGHT 

In  measures  of  weight  the  gram  is  the  unit. 

1  gram    1.0  gm. 

1  decigram    0.1  gm. 

1  centigram    0.01  gm. 

1  milligram    0.001  gm. 

TABLE  OF  EaiTIVALENTS 

Appended  is  a  table  of  all  the  denominations  of  weights 
and  measures,  opposite  which  are  placed  the  metric  system, 
with  corresponding  equivalents  in  wine  measure  and  avoirdu- 
pois weights : 


. .  z=     1.0  CC. 

.  .  =  10.00  CC. 

..  .  =    0.1  CC. 

j  =    0.001  CC. 


102 


PRACTICAL  DIETETICS 


APPROXIM  ATE 

EXACT 

LIQUIDS 

EQUIVALENT 

EQUIVALENT 

0.06  Cubic  centi- 

0.061 Cc. 

metre 

4  Cc. 

3.696  Cc. 

30  Cc. 

29.574  Cc. 

4  fl.  OZS.  or  J  pint.  .  .  . 

118  Cc.  (i  Liter) 

118.295  Co. 

8  fl.  ozs.  or  1  pint. .  .  . 

236  Cc.  il  Liter) 

236.590  Cc. 

16  fl.  ozs.  or  1  pint. .  .  . 

473  Cc.  (i  Liter) 

473.197  Cc. 

2  pints   

1  Liter  (1000  Cc.) 

.946  Liter. 

4  pints  or  i  gallon .  .  . 

2  Liters. 

1.892  Liters. 

1  gallon   

4  Liters. 

3.785  Liters. 

1  Cubic  centimeter. 

16  minims. 

16.23  mins. 

4  Cc  

1  fluid  drachm. 

1.082  fl.  drs. 

i  fl.  oz.  (4  fl.  drs.) 

4.057  fl.  drs. 

25  Cc  

61  fl.  drs. 

6.762  fl.  drs. 

1  fl.  oz. 

1.014  fl.  ozs. 

60  Cc  

2  fl.  ozs. 

2.029  fl.  ozs. 

100  Cc  

3^  fl.  ozs. 

3.381  fl.  ozs. 

120  Cc  

4  fl.  ozs.  (i  pint) 

4.057  fl.  ozs. 

125  Cc  

4i  fl.  ozs. 

4.227  fl.  ozs. 

"235  Cc  

8  fl.  ozs.  (i  pint) 

7.945  fl.  ozs. 

250  Cc  

8i  fl.  ozs. 

8.453  fl.  ozs. 

300  Cc  

10  fl.  ozs. 

10.144  fl.  ozs. 

470  Cc 

1  pint. 

1     RQ^  fl  nzq 

500  Cc  

1  pint  1  fl.  oz. 

1.056  pints. 

950  Cc  

2  pints. 

2.007  pints. 

1000  Cc.  (1  Liter)  

2  1-10  pints. 

2.113  pints. 

1  gallon. 

1.056  gals. 

SOLIDS 

APPROXIMATE 

EXACT 

EQUIVALENT 

EQUIVALENT 

0.00013  Gm. 

0.000129  Gm. 

1-150  gr  

0.00043  Gm. 

0.000432  Gm. 

1-120  gr  

0.00054  Gm. 

0.000540  Gm. 

1-100  gr  

0.00065  Gm. 

0.000648  Gm. 

0.001  Gm. 

0.001013  Gm. 

( 1  milligramme.) 

MEASURES  AND  WEIGHTS 


103 


SOLIDS 


APPROXIMATE 
EQUIVALENT 


EXACT 
EQUIVALENT 


1-50  gr 
1-40  gr 
1-32  gr 
1-25  gr 
1-10  gr 
1-3  gr. 
1  gr... 
5   grs . . 

15  grs . 
30  grs. 
60   grs . 

i  oz. 

i  oz. 

1  oz.  . , 

2  ozs. 

I  lb.  , 
i  lb. 

1  lb.   .  , 

2  lbs. 


0.0013  Gm. 
0.0016  Gm. 
0.002  Gm. 
0.0026  Gm. 
0.0065  Gm. 
0.021  Gm. 
0.065  Gm. 


0.3  Gm. 

0.324  Gm. 

( 3  decigrammes. ) 

1  Gm. 

0.972  Gm. 

2  Gm. 

1.944  Gm. 

4  Gm. 

3.888  Gm. 

3.5  Gm. 

3.544  Gm. 

14.2  Gm. 

14.175  Gm. 

28  Gm. 

28.350  Gm. 

56  Gm. 

56.699  Gm. 

113  Gm. 

113.398  Gm. 

225  Gm. 

226.796  Gm. 

450  Gm. 

453.592  Gm. 

900  Gm. 

907.185  Gm. 

0.001296 
0.001620 
0.002025 
0.002592 
0.006479 
0.021599 
0.064798 


Gm. 
Gm. 
Gm. 
Gm. 
Gm. 
Gm. 
Gm. 


1  milligramme 

(0.001  Gm.)  . .  . . 
10  milligrammes 

(0.01  Gm.)  

(—1  centigramme.) 
100  milligrammes 

(0.1  Gm.)  

(=1  decigramme.) 

1  Gramme   

4  Gm  

10  Gm.  (1  deka- 

gramme)   

25  Gm  

28  Gm  

56  Gm  

100  Gm.  (1  hekto- 

gramme)   

113  Gm  

200  Gm  


1-65  grain. 
1-6  gr. 

li  grs. 
15^  grs. 

60  grs.  (1  dr.  Troy) 

I  oz. 
i  oz. 

1  oz.  (437 J  grs.) 

2  ozs. 

3|  ozs. 


0.015  grain. 
0.154  gr. 

1.543  grs. 

15.4324  grs. 
61.729  grs. 

154.324  grs. 
385.81  grs. 
432.107  grs. 
1  oz.  426.7  grs. 

3  ozs.  230.7  grs. 


4  ozs.  (J  lb.) 
7  ozs. 


3  ozs.  431.3  grs. 
7  ozs.  24  grs. 


104 


PRACTICAL  DIETETICS 


SOLIDS 

APPROXIMATE 
EQUIVALENT 

EXACT 
EQUIVALENT 

225 

Gm  

o  ozs.  (5  Id.) 

7  ozs.  410  grs. 

250 

Gm  

8|  ozs.* 

8  ozs.  358  grs. 

450 

Gm  

1  lb.  (7000  grs.) 

15  ozs.  382  grs. 

500 

Gm  

1  1-10  lbs. 

1  lb.  1  oz.  279  grs. 

900 

Gm  

2  lbs. 

1  lb.  15  ozs.  327  grs. 

1000 

Gm.  (1  kilo- 

gramme or  Kilo) 

2i  lbs.. 

2  lbs.  3  ozs.  120  grs. 

TABLE  FOR  PREPARING  PERCENTAGE  SOLUTIONS 

Public  Charities  and  the  Department  of  Bellevue  and  Allied 
Hospitals  1 

One  fluid  ounce  of  water,  or  480  minims^  weighs  456.4 
grains.  One  pint  of  water,  or  7680  minims^  weighs  7300,  or 
practically  7300  grains.  Hence,  a  10  per  cent,  solution,  for 
instance,  is  one  which  contains  730  grains  of  some  substance 
in  1  pint. 

The  following  table  will  show  at  a  glance  the  quantity  of 
any  substance,  by  weight,  required  to  prepare  one  pint  of  a 
solution : 


1.  To  Prepare  One  Pint  of  a  Solution 


REQUIRED   TO   CONTAIN   OF   A  CERTAIN 
SUBSTANCE 

TAKE   OF   THE  SUBSTANCE 
BELOW  STATED  AMOUNT 
IN         GRAINS  WITH 
ENOUGH       WATER  TO 
MAKE   1  PINT. 

PER  CENT. 

OR 

.......... 

Y  "   

^7   

1  « 

To 

1  (( 
TO   

1   in  10,000 
1   in  5,000 
1   in  4,000 
1    in  3,000 
1    in  2,500 
1    in  2,000 
1    in  1,500 
1   in  1,000 

Grains  0.73 

1.46  (11) 
1.83  (1|) 
2.44  (2i) 
2.92  (3) 
3.65  (31) 
4.87  (41) 
7.30  (74) 

1  Arranged  by  the  Public  Charities  and  the  Department  of  Bellevue  and 
Allied  Hospitals. 


MEASURES  AND  WEIGHTS  105 


REQUIRED  TO  CONTAIN  OF 
SUBSTANCE 

A  CERTAIN 

TAKE  OF  THE  SUBSTANCE 
BELOW  STATED  AMOUNT 
IN         GRAINS  WITH 
ENOUGH       WATER  TO 
MAKE  1  PINT. 

PER  CENT. 

OR 

1 

in 

500 

Grains  14.60 

(141) 

i  "   

in 

400 

18.25 

(18i) 

h  "   

in 

300 

"  24.33 

(241) 

i  "   

in 

200 

36.50 

(361) 

1   

in 

100 

73.00 

(73) 

11 

in 

75 

97.33 

(97) 

2 

in 

50 

146.00 

(146) 

2i  "   

in 

40 

182.50 

(180) 

3  "   

in 

33J 

219.22 

(220) 

4  "   

in 

25 

292.00 

(290) 

5  "   

in 

20 

365.00 

(365) 

10  "   

in 

10 

730.00 

(730) 

20  "   

in 

5 

1460.00 

(1460) 

25   

in 

4 

1825.00 

(1825)  . 

50  "   

in 

2 

3650.00 

(3650) 

2.  To  Prepare  One  Fluid  Ounce  of  a  Solution 


REQUIRED  TO  CONTAIN  OF 
A  SUBSTANCE 

TAKE  OF  THE 

SUBSTANCE 

APPROX. 

0.1 

per  cent  

0.46  grain 

(i  gr,) 

0.5 

(( 

2.28  " 

m 

it  \ 

1 

ie 

4.56  " 

(4i 

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106 


PRACTICAL  DIETETICS 


THERMOMETRY 

The  thermometers  used  by  the  nurse  in  cookery^  in  regu- 
lating the  heat  of  the  room  or  in  taking  the  patient's  tempera- 
tures are  chiefly  of  the  Fahrenheit  scale.  Scientists  employ 
the  Centigrade  scale  in  most  countries.  While  thermometers 
are  made  with  both  scales^,  it  is  a  simple  matter  to  translate 
the  ordinary  Fahrenheit  to  Centigrade. 

The  freezing  point  of  the  latter  is  0°,  while  that  of  the 
former  is  32°  above  0. 

The  boiling  point  of  the  latter  is  100°,  while  that  of  the 
former  is  212°. 

Hence,  to  change  Fahrenheit  to  Centigrade,  we  subtract 
32°  from  212°  in  order  that  the  freezing  points  correspond, 
which  leaves  180°  F.=  100°  C.  A  degree  Centigrade  is 
therefore  5/9  of  a  degree  Fahrenheit. 

To  change  Centigrade  to  Fahrenheit,  every  Fahrenheit  de- 
gree is  9/5  times  as  large  as  a  Centigrade  degree.  It  is  also 
necessary  to  add  32°  to  the  result. 

Examples:    Change  212°  Fahrenheit  to  Centigrade. 
212°— 32°=!  180°  X  5-9  =  100°  C. 
Change  100°  Centrigrade  to  Fahrenheit. 
100°  X  9-5  =  180°  +  32°  =  212°  F. 


Note  from  page  11. 

*  Not  all  proteins  are  equally  advantageous.  Studies  of  farm  animals  show, 
for  instance,  that  corn  protein  alone  does  not  produce  the  best  growth,  but 
needs  to  be  supplemented  by  other  proteins.  Investigations  with  pure  isolated 
proteins  of  various  kinds  prove  that  some  of  them  (as  casein  and  edestin) 
will  serve  as  the  sole  source  of  nitrogen,  both  for  the  young  animal  and  the 
adult;  others,  as  gliadin  of  wheat,  will  maintain  the  mother  but  not  the  grow- 
ing organism;  while  still  others,  as  zein  of  corn  or  gelatin,  will  support  neither 
the  adult  nor  the  young.  This  is  explained  by  the  difference  in  the  constitution 
of  the  proteins.  Tliey  are  all  made  up  of  simpler  chemical  compounds 
called  amino  acids,  some  fifteen  to  twenty  being  present  in  a  single  protein. 
Of  these,  two  are  demonstrated  to  be  especially  important  to  the  body,  namely, 
tryptophane  and  lysine.  Without  them  there  can  be  no  growth  in  the  young 
nor  repair  in  the  adult.  Proteins  which  contain  all  the  essential  amino 
acids  are  called  "complete" ;  those  which  have  enough  for  all  building  pur- 
poses in  the  adult,  but  not  in  the  young,  are  "partially  incomplete" ;  and 
those  which  have  to  be  supplemented  by  other  proteins  (or  experimentally  by 
the  lacking  amino  acids)  are  "incomplete."  One  advantage  in  the  use  of 
milk  and  eggs  in  the  diet  is  the  assurance  of  having  a  supply  of  complete 
proteins.  As  already  stated,  gelatin  will  serve  about  two-thirds  of  the  adult 
need  of  protein. 


PAET  II 

BEVEEAGES 
ANIMAL  FOODS 
VEGETABLE  FOODS 
NUTEITIOUS  DESSEETS 


CHAPTEK  VIII 


BEVERAGES 

ACID  —  ALBUMINOXTS  —  STARCHY  —  MISCELLANEOUS  BEVER- 
AGES, INCLUDING  TEA,  COFFEE,  CHOCOLATE,  AND  COCOA, 
AND  SPECIAL  NON-NUTRITIVE  BEVERAGES 

Beverages  serve  primarily  to  relieve  thirst.  The  universal 
beverage  is  water.^  Other  beverages  answer  the  same  pur- 
pose^ because  their  chief  constituent  is  water.  They  are  also 
taken  for  their  temperature  —  cold  or  hot;  for  their  flavor, 
which  helps  to  arouse  or  appease  the  appetite;  or  for  their 
stimulating  properties.  Usually  they  have  little  or  no  energy 
value,  but  when  made  with  milk,  eggs,  cocoa,  chocolate  or 
other  highly  nutritive  materials,  they  become  a  valuable 
means  of  administering  food  in  a  liquid  form. 

All  beverages  need  to  be  made  with  much  care  and  served 
daintily.  Hot  drinks  should  be  served  at  a  temperature  of 
122-140°  P.  When  water  is  used  it  should  be  freshly 
drawn,  brought  to  a  boil  and  used  at  once.  This  serves  to 
sterilize  it  and  also  to  develop  a  better  flavor. 

Cold  drinks  should  be  given  thoroughly  cooled,  but  iced 
liquids  lower  the  temperature  of  the  stomach  unless  sipped 
very  slowly,  and  thus  tend  to  retard  digestion.  They  are 
therefore  better  for  serving  between  meals  than  with  them. 
Do  not  use  ice  in  a  beverage  unless  it  is  made  from  pure  water, 
but  cool  by  placing  the  receptacle  on  ice.  Use  a  separate 
spoon,  and  taste  every  beverage  just  before  serving  to  be  sure 
it  is  properly  seasoned  and  of  correct  temperature. 

Never  allow  a  drink  to  stand  any  length  of  time  in  a  sick 
room.  If  it  has  to  be  carried  any  distance,  be  sure  that  it 
is  covered. 

^  See  Water,  page  23. 

109 


110 


BEVERAGES 


ACID  BEVERAGES 

Beverages  made  from  fruit  juices  are  cooling  and  refresh- 
ings and  hence  especially  grateful  to  fever  patients.  They 
are  valuable  for  the  organic  acids^  mineral  matter^  and  sugar 
which  they  contain.  Some  of  them^  as  lemonade  and  orange- 
ade, have  an  added  value  in  their  diuretic  and  diaphoretic 
action.  The  organic  acids  are  useful  in  constipation,  as  they 
stimulate  peristaltic  action.  These  acids  vary  with  the  kind 
of  fruit;  thus,  apples  contain  malic  acid;  lemons,  citric  acid; 
grapes,  tartaric  acid,  etc.  These  acids,  as  elsewhere  stated,^ 
occur  in  the  form  of  acid  salts,  usually  of  potassium,  and  in 
the  body  are  changed  to  carbonates,  which  preserve  the  alka- 
linity of  the  blood.  Eipe  pineapple  juice  contains  a  ferment 
capable  of  digesting  proteins. 

Wash  lemons  and  oranges,  and  in  using  the  juice  remove 
the  seeds,  as  they  give  a  bitter  taste.  When  the  rind  of  lemon 
or  orange  is  undesirable  medicinally,  it  should  not  be  used. 

Serve  acid  beverages  daintily  in  glasses  or  sherbet  cups 
(three-fourths  filled),  pass  on  small  tray  or  plate,  covered 
with  doily,  and  add  a  few  wafer  crackers,  or  a  single  flower. 

Sweetening  Acid  Drinks.  For  the  diabetic,  sugar  must  be 
replaced  by  Sweetina. 

Whenever  cold  water  is  to  be  used  instead  of  very  hot  or 
boiling  water  in  preparing  the  drinks,  it  is  preferable  to  use 

sugar  syrup  for  sweetening  in  place  of  sugar,  which  re- 
quires time  for  solution. 

As  the  acidity  of  fruit  varies  considerably  with  the  kind, 
and  with  the  season  of  year,  this  fact  must  be  borne  in  mind 
while  preparing  the  foregoing  recipes,  otherwise  too  much 
sugar  may  be  added. 

SUGAR  SYRTJP,  420  CALORIES 

%  cup  of  sugar.  i/^  cup  of  boiling  water. 

Mix  the  sugar  and  water  and  stir  until  the  sugar  is  dis- 

^  See  Mineral  Matter,  p.  31. 


ACID  BEVERAGES 


111 


solved.  Boil  slowly,  without  stirring^  for  fifteen  minutes; 
cool  slightly  and  bottle. 

LEMONADE,  137  CALORIES 

1  lemon.  2  tablespoons  sugar. 
%  cup  boiling  water.  %  thin  slice  lemon. 

Wash  and  wipe  lemon;  cut  a  very  thin  slice  from  middle. 
Squeeze  juice  into  a  bowl  (keeping  back  the  seeds),  add  the 
sugar  and  boiling  water;  cover,  and  put  on  ice  to  cool. 
Strain  and  pour  into  a  glass  or  sherbet  cup. 

Cut  half  the  slice  of  lemon  into  two  pieces,  and  use  as 
garnish  in  glass;  or  a  few  berries  or  slice  of  orange  may  be 
used. 

Note. —  The  quantity  of  sugar  used  depends  upon  the 
acidity  of  fruit. 

FETTIT  LEMONADE 

Add  fresh  fruit  of  all  kinds  to  strong  lemonade,  using  boil- 
ing water  for  the  beverage,  cool,  and  chill  on  ice. 

BRAN  LEMONADE,  20  CALORIES 
l^  cup  wheat  bran.  Juice  1  lemon. 

2  cups  cold  water. 

Allow  the  bran  and  water  to  stand  overnight.  Strain,  and 
add  the  juice  of  the  lemon. 

SODA  OR  WHITE  ROCK  WATER  LEMONADE,  137  CALORIES 

Juice  of  1  lemon.  l^  teaspoon    soda,     free  from 

1  or  2  tablespoons  sugar.  lumps. 
%  cup  cold  water. 

Prepare  the  lemonade  to  taste,  cool,  add  the  soda,  stir 
thoroughly,  and  drink  while  effervescing. 

Note. —  Put  glass  on  plate  when  soda  is  added.  Water  and 
soda  may  be  omitted  and  White  Kock  Water  substituted. 

PINEAPPLE  LEMONADE,  186  CALORIES 

l^  cup  grated  pineapple  or  juice.  %  cup  boiling  water. 
Juice  1  lemon.  1  cup  ice-cold  water. 

2  tablespoons  sugar. 


113 


BEVERAGES 


Mix  pineapple,  lemon  juice  and  sugar,  and  add  the  boiling 
water.    Cool,  add  ice-cold  water,  strain  and  serve. 

Note. —  Canned  pineapple  may  be  used  or  pineapple 
juice. 

IRISH  MOSS  LEMONADE,  25  CALORIES  i 

%  cup  Irish  moss.  4  tablespoons  lemon  juice. 

2  cups  cold  water.  Sugar. 

Soak,  pick  over  and  wash  the  moss  (soaking  15  minutes). 
Drain  and  add  the  cold  water;  cook  in  top  of  double  boiler 
about  20  minutes  or  until  syrupy.  If  it  becomes  too  thick, 
add  hot  water.  Strain,  add  the  lemon  juice  and  sugar  to 
taste.    Eeheat  and  serve  hot. 

Excellent  for  sore  throat  and  cold  on  the  lungs,  or  any 
inflammation  of  the  mucous  membrane. 

GRAPE  LEMONADE,  200  CALORIES 

Make  one  cup  lemonade,  rather  sweet,  add  one-fourth  cup 
Welches  Grape  Juice. 

EGG  LEMONADE 

See    Albuminous  Beverages    for  recipe.    Page  121. 

ORANGEADE,  197  CALORIES 

1  sour  orange.  2  tablespoons  sugar. 

%  cup  boiling  water.  %  slice  orange. 

Prepare  as  for.  lemonade.  If  orange  is  not  very  acid,  add 
a  little  lemon  juice  or  use  less  sugar. 

ORANGEADE  NO.  II,  77  CALORIES 

Put  two  tablespoons  of  crushed  ice  in  dainty  glasses  and 
pour  the  juice  of  one  orange  over  it.    Sweeten  if  desired. 

FRTTITADE,  45  CALORIES 

%  cup  grated  pineapple  1  cup  boiling  water. 

Juice  l^  lemon.  Sugar. 
Juice  %  orange. 

Prepare  fruit.  Add  the  boiling  water  and  one  tablespoon 
sugar;  allow  to  stand  until  cool.  Add  more  water  or  sugar 
if  necessary.    Strain  and  serve  cold. 

1  Without  sugar. 


ACID  BEVERAGES 


113 


PINEAPPLE  JUICE,  ABOTTT  50  CALORIES 

%  cup  Pineapple  Juice.  Crushed  Ice. 

Pour  the  pineapple  juice  over  crushed  ice  and  serve  in 
dainty  glasses.  This  is  delicious  and  has  remedial  qualities; 
especially  valuable  in  throat  and  stomach  trouble. 

LEMON  WHEY,  96  CALORIES 

1  cup  hot  milk.  2  tablespoons  lemon  juice. 

2  teaspoons  sugar. 

Heat  the  milk  in  a  small  saucepan  over  hot  water,  or  in  a 
double-boiler.  Add  the  lemon  juice.  Cook  without  stirring 
until  the  whey  separates.  Strain  through  cheese-cloth,  and 
add  the  sugar.  Serve  hot  or  cold.  Garnish  with  small  pieces 
of  slice  of  lemon. 

WINE  WHEY,  84  CALORIES 

1  cup  sweet  milk.  %  cup  sherry  wine. 

Heat  the  milk  to  boiling  point,  add  the  wine,  and  cook  with- 
out stirring  until  the  milk  separates.  Strain  through  a  fine 
strainer,  and  serve  hot  or  cold. 

ACID  PHOSPHATE 

Horsford's  Acid  Phosphate  is  a  solution  of  the  phosphates 
of  lime,  magnesia,  potash  and  iron  with  phosphoric  acid, 
in  such  form  as  to  be  readily  assimilated  by  the  system.  It 
is  thus  a  true  nerve  and  tissue  food. 

1  teaspoon  Horsford's  Acid  Phos-  1  cup  hot  or  cold  water, 
phate.  Sugar. 

Mix  the  Acid  Phosphate  with  the  water  and  sweeten  with 
sugar,  if  desired. 

If  the  above  should  seem  too  strong,  or  be  found  too  stimu- 
lating, use  one-half  teaspoon  of  the  Acid  Phosphate. 

Note. —  Horsford's  Acid  Phosphate  can  be  substituted  for 
lemon  juice  in  any  of  the  acid  drinks. 

ACID  PHOSPHATE  WHEY,  56  CALORIES 

1  cup  hot  milk.  1  teaspoon  Horsford's  Acid  Phos- 

2  teaspoons  sugar,  phate. 


114 


BEVERAGES 


Heat  the  milk  in  a  small  saucepan  over  hot  water  or  in 
a  double  boiler.  Add  the  Acid  Phosphate.  Cook  without 
stirring  until  the  whey  separates.  Strain  through  cheese- 
cloth and  add  the  sugar.  If  more  acid  is  desired,  add  two 
or  three  drops  of  Horsford's  Acid  Phosphate.  Serve  hot  or 
cold. 

CREAM  OF  TARTAR  DRINK 

1   or   114   teaspoons   Cream.  Lemon. 

of  Tartar.  Sugar. 
1  pint  boiling  water. 

Dissolve  the  cream  of  tartar  in  the  boiling  water,  and 
flavor  with  lemon  and  sugar.  When  cold  strain.  Take  as  a 
refrigerant  drink  and  diuretic. 

MALTED  MILK  AND  CURRANT  JELLY,  85  CALORIES 

1   tablespoon   Horlick's   Malted   1  tablespoon  currant  jelly. 

Milk.  %  cup  cold  water. 

%  cup  boiling  water.  Cracked  ice. 

Mix  the  malted  milk  powder  with  a  little  of  the  boiling 
water  to  make  a  smooth  paste,  add  the  jelly  and  the  rest  of 
the  water,  and  stir  till  the  jelly  is  dissolved.  Add  the  cold 
water  and  ice,  strain  and  serve  daintily  in  glass  or  sherbet 
cup,  partly  filled,  and  set  on  a  small  plate  with  doily. 

MALTED  MILK  WITH  WINE,  88  CALORIES 

1    tablespoon   Horlick's   Malted  1  teaspoon  port  or  sherry  wine. 

Milk.  1  teaspoon  sugar. 

1  cup  hot  water. 

Mix  the  malted  milk  powder  v/ith  enough  of  the  hot  water 
to  make  a  smooth  paste,  then  add  gradually  the  rest  of  the 
hot  water,  the  wine,  and  sugar  if  desired. 

JELLY  AND  ICE 

With  a  large  needle  or  pin,  chip  half  a  cup  of  ice  into 
bits  as  large  as  a  pea  (or  use  an  ice-scraper).  Mix  with  it 
about  the  same  quantity  of  lemon,  currant,  blackberry,  or 
barberry  jelly.  Very  refreshing  in  fevers.  Be  sure  ice  is 
perfectly  pure. 


ACID  BEVERAGES 


115 


GRAPE  WATER,  135  CALORIES  i 

4  tablespoons  grape  jelly.  %  cup  cold  water. 

l^  cup  boiling  water.  Lemon  juice  and  sugar. 

Dissolve  the  jelly  in  the  boiling  water,  then  add  the  cold 
water,  season  to  taste.    Serve  ice  cold, 

CURRANT  WATER,  100-125  CALORIES  i 

14  cup  currant  juice  or  %  cup  cold  water. 

4  tablespoons  currant  jelly.  Lemon  juice  and  sugar. 

l^  cup  boiling  water. 

Dissolve  the  jelly  in  the  boiling  water  (put  over  heat  a 
few  moments  if  it  does  not  dissolve  quickly).  When  dis- 
solved add  the  cold  water,  sweeten  to  taste,  and  add  a  little 
lemon  juice,  if  desired.    Serve  cold. 

APPLE,  WATER,  25  CALORIES  1 

1  sour  apple.  Lemon  juice. 

1  cup  boiling  water.  Sugar. 

Wipe  a  rosy-cheeked  sour  apple,  and,  without  paring  it, 
cut  it  into  small  pieces.  Add  the  boiling  water  and  one  table- 
spoon sugar.  Cover,  and  let  it  stand  till  cold,  then  strain, 
and  add  lemon  juice  and  sugar  to  taste.    Serve  cold. 

Note. —  Dried  apple  may  be  substituted,  or  two  baked  ap- 
ples. 

RHUBARB  WATER,  15  CALORIES  1 

1  stalk  rhubarb.  Lemon  juice. 

1  cup  boiling  water.  Sugar. 

Wash  and  wipe  the  rhubarb,  and  cut  in  thin  slices,  leaving 
on  the  skin.  Add  the  boiling  water  and  one  tablespoon  sugar. 
Cover,  and  let  stand  till  cold.  Strain,  add  lemon  juice  and 
sugar  to  taste,  and  serve  cold. 

TAMARIND  WATER,  60  CALORIES  2 

2  tablespoons    preserved   tama-   1  cup  boiling  water, 
rinds.  Sugar. 

Pour  the  water  over  the  tamarinds  and  let  stand  one-half 
hour.    Sweeten  to  taste,  strain  and  serve  cold. 

^  Without  lemon  juice  or  sugar. 

2  Without  sugar.    Estimated  from  average  composition  of  preserves. 


116 


BEVERAGES 


TAMARIND  MALTED  MILK,  115  CALORIES 

2  tablespoons  Horlick's  Malted   %  cup  hot  water. 

Milk.  %  cup  cold  water. 

1  tablespoon  tamarinds.  Cracked  ice. 

Make  a  smooth  paste  of  the  malted  milk  powder  and  hot 
"water,  add  preserved  tamarinds  and  the  cold  water.  Strain 
and  chill,  or  add  pure  cracked  ice. 

GRAPE  JUICE 

(1^  cup  =  120  Calories.) 

Partially  fill  a  small  glass  with  crushed  ice,  and  add  Welch's 
Grape  Juice  and  serve. 

Grape  juice  is  a  tonic  food  and  a  medicine  for  the  sick 
and  convalescent.  It  may  be  served  plain,  cold  or  hot,  or 
diluted  with  one-third  water.  It  is  preferable  to  keep  and 
serve  the  juice  very  cold.  The  bottles  may  be  kept  on  ice 
until  ready  to  serve. 

GRAPE  LITHIA,  75  CALORIES 

Pour  one  ounce  of  Welches  Grape  Juice  into  a  glass,  dis- 
solve in  it  two  teaspoons  of  sugar,  and  add  four  ounces  of 
lithia  water. 

GRAPE  NECTAR,  2750  CALORIES 

(About  2  Quarts.) 

Boil  together  one  pound  of  sugar  and  one-half  pint  of 
water  until  it  spins  a  thread ;  remove  from  the  fire,  and  when 
cool,  add  the  juice  of  six  lemons  and  one  quart  of  Welch's 
Grape  Juice.  Let  stand  over  night.  Serve  with  ice  water, 
Apollinaris  or  plain  soda. 

TEA  PUNCH 

Pew  beverages  find  readier  favor  during  the  hot  weather 
than  tea  punch.  To  make  it,  pour  boiling  lemonade,  sweet- 
ened to  taste,  over  the  tea  leaves,  and  allow  the  liquid  to  stand 
until  cold.  Then  strain  and  serve  in  tall  glasses,  with  shaved 
ice  and  slices  of  lemon. 


ACID  BEVERAGES 


2  large  teaspoons  tea. 
2  quarts  boiling  water. 
1  pound  lump  sugar. 
8  lemons. 


Steep  the  tea  in  the  boiling  water  for  five  minutes^  strain 
and  add  the  sugar^  stirring  until  thoroughly  dissolved.  Grate 
the  rind  of  the  lemons  and  extract  all  the  juice.  Cut  the 
oranges  into  slices,  shred  the  pineapple,  slice  the  bananas 
very  thin  and  hull  the  strawberries.  When  the  tea  is  cold 
add  all  the  fruit,  and  let  stand  in  the  refrigerator  for  several 
hours.  Place  a  cube  of  ice  in  the  punch-bowl,  pour  the  mix- 
ture around  it,  and  when  well  chilled  serve  in  punch  glasses. 
If  desired,  one  cup  of  Maraschino  cherries  may  be  added. 

To  get  the  best  results  from  the  pineapple,  pare  and  remove 
the  eyes,  tear  apart  with  a  silver  knife  and  fork,  reject  the 
core,  sprinkle  with  sugar  and  let  stand  on  ice  for  twelve 
hours. 

While  fresh  fruits  are  always  preferable,  canned  berries 
and  pineapples  may  be  substituted. 


2  dozen  Malaga  grapes. 

Boil  together  for  five  minutes  the  water  and  sugar.  Add 
the  grated  rind  of  two  lemons  and  four  oranges,  and  continue 
boiling  for  ten  minutes  longer.  Strain  the  syrup  through 
cheese-cloth,  and  add  one  quart  of  cold  water.  Extract  the 
juice  from  the  lemons  and  oranges,  strain  and  mix  with  two 
dozen  Malaga  grapes,  cut  in  half  and  seeded,  the  tangerine 
oranges  sliced,  the  pineapple  shredded,  the  banana  cut  in 
slices,  and  one  pint  bottle  of  Maraschino  cherries  with  their 


TUTTI-FRTJTTI  PUNCH,  2300  CALORIES 

(3  Quarts.) 


2  quarts  water. 

1  pound  sugar. 

2  lemons. 
4  oranges. 


2  tangerine  oranges. 
4  slices  pineapple. 
1  banana. 

1  pint  Maraschino  cherries. 


118 


BEVERAGES 


liquor.  Add  the  fruit  to  the  syrup,  chill  and  serve  same  as 
Pruit  Punch. 

ALBUMINOUS  BEVERAGES 

When  a  large  amount  of  nutriment  is  required  the  al- 
buminized drinks  are  valuable. 

The  egg  is  a  fluid  food  until  its  albumin  is  coagulated  by 
heat.  Often  the  white  of  egg,  dissolved  in  water  or  milk, 
and  flavored,  is  given  when  the  yolk  cannot  be  digested,  as 
30  per  cent,  of  the  yolk  is  fat.  Egg-nog  is  very  nutritious, 
and  is  extensively  prescribed  in  certain  non-febrile  diseases, 
especially  for  the  forced  alimentation  of  phthisis  and  melan- 
cholia. There  are  occasional  cases  of  bilious  habit,  in  which 
eggs  to  be  digested  must  be  beaten  in  wine.  But  the  combi- 
nation of  egg,  milk  and  sugar  with  alcohol,  which  constitutes 
egg-nog,  is  apt  to  produce  nausea  and  vomiting  in  a  feeble 
stomach,  especially  in  fever.  For  this  reason  whole  eggs  are 
unfit  for  fever  patients,  and  the  whites  only  should  be  used. 

.Albuminized  drinks  are  most  easily  prepared  cold.  When 
a  hot  liquid  is  used,  it  must  be  poured  very  slowly  into,  the 
well-beaten  egg,  stirring  constantly,  so  that  lumps  of  coagu- 
lated albumin  do  not  form. 

For  the  Diabetic.  In  all  the  albuminous  drinks  substitute 
Sweetina  for  the  sugar.  The  fuel  value  will  be  60  calories 
less  in  every  recipe  than  when  one  tablespoon  of  sugar  is 
used. 

ENERGY  VALUE  OF  AN  EGG 

1  medium  egg  (without  shell)  =60  Calories. 

1  white  of  egg  (average)  =13  " 

1  yolk  of  egg  (average)  =48  " 

EGG  BROTH,  319  CALORIES  i 

Yolk  1  egg.  Speck  salt. 

1  tablespoon  sugar.  1  cup  hot  milk. 

Brandy  or  some  other  stimulant  if  requited. 

Beat  egg,  add  sugar  and  salt.  Pour  on  carefully  the  hot 
milk.  Flavor  as  desired,  if  with  brandy  or  wine,  use  about 
one  tablespoon. 

1  Calculated  with  1  thsp.  hrandy.    277  Calories  if  hrandy  is  omitted. 


ALBUMINOUS  BEVERAGES 


119 


Note. —  Dried  and  rolled  bread  crumbs  may  be  added,  if 
desired.  The  whole  egg  may  be  used.  Hot  water,  broth  or 
coffee,  may  be  substituted  for  the  milk ;  nutmeg  may  be  sub- 
jstituted  for  the  stimulant.' 

EGG-NOG  NO.  I,  231  CALORIES  i 

1  egg.  %  cup  milk. 

Speck  salt.  IV2  tablespoon  wine  or 

%  tablespoon  sugar.  1  tablespoon  brandy  (or  less). 

Beat  the  egg,  add  the  sugar  and  salt ;  blend  thoroughly,  add 
the  milk  and  liquor.    Serve  immediately. 

Note. —  Have  eggs  and  milk  chilled  before  blending.  A 
grating  of  nutmeg  may  be  substituted  for  the  stimulant.  A 
lemonade  shaker  may  be  used  for  the  blending. 

EGG-NOG  NO.  II,  231  CALORIES  1 

1  egg.  %  cup  milk. 

%  tablespoon  sugar.  1  tablespoon  brandy  (or  less). 

Speck  salt. 

Separate  egg.  Beat  yolk,  add  sugar  and  salt,  and  beat  until 
creamy.  Add  the  milk  and  brandy.  Beat  the  white  till 
foamy  (not  stiff  and  dry),  and  fold  it  in  lightly.  Serve  im- 
mediately. 

JUNKET  EGG-NOG,  289  CALORIES  1 

1  egg.  2    teaspoons    rum,    brandy,  or 

1  cup  milk.  wine. 

1  tablespoon  sugar.  %  Hansen's  Junket  Tablet. 

Beat  white  and  yolk  of  egg  separately, ' very  light;  blend 
the  two.  Add  the  sugar  dissolved  in  the  rum.  Heat  the 
milk  lukawarm,  stir  into  the  egg  mixture,  and  add  quickly 
the  tablet  dissolved  in  cold  water.  Pour  into  small  warm 
glasses,  and  sprinkle  grated  nutmeg  over  the  top.  Stand-in 
warm  room  undisturbed  until  firm,  and  then  put  on  ice  to 
cool.    This  can  be  retained  by  the  most  delicate  stomach. 

*  Without  liquor. 


120  BEVERAGES 

BEEF  EGG-NOG,  200  CALORIES 

1  egg.  %  cup  hot  beef  broth. 

Speck  salt.  1  tablespoon  brandy. 


1  tablespoon  sugar. 

Beat  the  egg  slightly,  add  the  salt  and  sugar;  add  grad- 
ually the  hot  broth ;  add  brandy  and  strain.  Sugar  and 
brandy  may  be  omitted  if  preferred. 

COFFEE  EGG-NOG,  175  CALORIES  i 

1  egg.  14  scant  cup  milk  or  cream. 

1%  teaspoon  sugar.  %  scant  cup  strong  coffee. 

Chill  ingredients,  and  blend  as  for  Egg-nog  ISo.  II. 

PINEAPPLE  EGG-NOG 
Prepare  as  per  Egg-nog  No.  I  or  II ;  omit  the  brandy  and 
use  pineapple  juice  to  taste. 

EGG  AND  RUM,  315  CALORIES 

Famous  in  the  Treatment  of  Phthisis 
1  cup  fresh  milk.  Speck  salt. 

Yolk  1  egg.  Few  grains  nutmeg. 

1  tablespoon  sugar.  1  tablespoon  rum. 

Beat  yolk,  add  sugar,  salt  and  nutmeg;  add  milk  and  rum. 

Note. —  For  consumptives,  taken  at  about  6  a.  m.,  often 
prevents  the  exhausting  sweats  which  accompany  the  morn- 
ing doze.  Also  may  be  given  to  a  patient  before  dressing  to 
prevent  exhaustion. 

EGG  AND  BRANDY,  350  CALORIES  2 

3  eggs.  4  tablespoons  brandy. 

4  tablespoons  cold  water.  Sugar. 
Xutmeg. 

Beat  the  eggs,  add  cold  water,  brandy  and  sweeten  to  taste. 
A  little  nutmeg  may  be  added.  Give  a  tablespoonful  at  a 
time. 

EGG  AND  WINE,  125  CALORIES  2 

1  egg.  1  wineglass  sherry. 

y<>  cup  cold  water.  Nutmeg. 

Sugar. 


^  Calculated  with  milk. 
2  Without  sugar. 


ALBUMINOUS  BEVERAGES  121 


Beat  the  egg.  Heat  the  water  and  wine  together  but  not 
boiling;  pour  onto  the  egg,  stirring  constantly;  flavor  with 
sugar  and  nutmeg. 

EGG  LEMONADE,  192  CALORIES 

1  egg.  2  tablespoons  lemon  juice. 

2  tablespoons  sugar.  1  cup  cold  water. 

Beat  the  egg  thoroughly,  add  the  sugar  and  lemon  juice; 
pour  in  gradually  the  water,  stirring  until  smooth  and  well 
mixed.  Strain  and  serve.  Two  tablespoons  of  sherry  or  port 
may  be  added  if  desired. 

MALTED  MILK  AND  EGG,  120  CALORIES 

1    tablespoon   Horlick's    Malted  20  drops  acid  phosphate. 
Milk.  1  tablespoon  crushed  ice. 

1  tablespoon  crushed  fruit.  %  cup  ice  water. 

1  egg. 

Mix  the  malted  milk  powder,  crushed  fruit  and  egg  and 
beat  nve  minutes.  Add  the  phosphate  and  crushed  ice,  blend- 
ing thoroughly.  Strain  and  add  ice  water  or  cold  carbonated 
water,  and  a  grating  of  nutmeg  to  flavor. 

STOKES  MIXTURE 

Eggs  and  Brandy  =  196  Calories. 

2  egg  yolks,  50  c.  c.  of  brandy,  120  c.  c.  of  aqua  aurantii 
florun  (sugar  or  syrup  enough  to  sweeten),  has  consider- 
able nutritive,  as  well  as  stimulative,  value,  and  is  eligible 
for  use  when  such  a  combination  is  indicated.'^ 

GRAPE  YOLK,  150  CALORIES 

1  egg.  2    tablespoons    Welch's  Grape 

1  tablespoon  sugar.  Juice. 
Speck  salt. 

Separate  egg.  Beat  yolk,  add  sugar  and  stand  aside  while 
the  white  is  thoroughly  whipped.  Add  the  grape  juice  to  the 
yolk  and  pour  this  onto  the  whipped  white,  blending  care- 
fully. Serve  cold.  Have  all  ingredients  chilled  before  blend- 
ing. 


132 


BEVERAGES 


GRAPE  JUICE  AND  EGG,  270  CALORIES 

1  egg.  1  tablespoon  sugar. 

1^  cup  rich  milk.  %  cup  Welch's  Grape  Juice. 

Beat  yolk  and  white  separately  very  light.  To  the  yolk 
add  milk^  sugar  and  grape  juice^  and  pour  into  glass.  To  the 
white  add  a  little  powdered  sugar  and  a  taste  of  grape  juice. 
Serve  on  yolk  mixture.    Chill  all  ingredients  before  using. 

MTJLLEI)  WINE,  250-280  CALORIES 

1  ounce  stick  cinnamon.  14  cup   sherry,   port,   or  claret 

A  slight  grating  nutmeg.  wine. 

Y2  cup  boiling  water.  2  tablespoons  sugar. 

1  egg. 

Put  the  spices  into  top  of  a  double  boiler  with  the  water. 
Cover  and  cook  over  hot  water  ten  minutes.  Add  wine  to  the 
spiced  water  and  bring  to  the  boiling  point.  Beat  the  egg 
to  a  stiff  frothy  add  sugar  and  pour  on  the  mulled  wine,  and 
beat  well.    Serve  at  once. 

ALBUMINIZED  MILK,  98  CALORIES 
%  cup  milk  (sterile).  Salt. 
White  1  egg. 

Put  milk  and  white  of  egg  in  a  glass  fruit  jar,  cover  with 
air  tight  cap  and  rubber  band.  Shake  until  thoroughly 
blended.  Strain  into  glass.  A  few  grains  of  salt  may  be  added 
if  desired.  Two  teaspoons  of  Sanatogen  added  =  30  calories. 

Note. —  The  blending  may  be  done  in  a  lemonade  shaker. 

ALBUMINIZED  WATER,  13  CALORIES  1 

^2  cup  ice-cold  water  Lemon  juice. 

(boiled  and  chilled).  Sugar. 
White  1  egg. 

Blend  as  for  "  Albuminized  Milk/^  serve  plain  or  add  lemon 
juice  and  sugar  to  taste.  If  set  on  ice  to  keep  cool,  shake  be- 
fore serving.  Two  teaspoons  of  Sanatogen  added  =  30  calories. 

ALBUMIN  WATER  (FOR  INFANTS),  13  CALORIES 

Albumin  water  is  utilized  chiefly  in  cases  of  acute  stomach 
and  intestinal  disorders  in  which  some  nutritious  and  easily 

^  Without  lemon  juice  or  sugar. 


ALBUMINOUS  BEVERAGES 


123 


assimilated  food  is  needed ;  albumin  water  is  then  very  useful. 
The  white  of  one  egg  is  dissolved  in  eight  ounces  or  a  pint 
of  water  which  has  been  boiled  and  cooled. —  Koplik. 

ALBUMINIZED  CLAM  WATER,  18  CALORIES 

1  cup  cold  water.  White  1  egg. 
Clam  Broth. 

To  the  water  add  the  required  amount  of  the  clam  broth 
to  make  the  strength  desired,  add  the  unbeaten  white  of  egg, 
and  follow  general  directions  for  "  Albuminized  Milk." 
Serve  cold  in  dainty  glasses.  This  is  a  very  nutritious  drink, 
and  will  be  retained  by  the  stomach  when  other  nourishment 
is  rejected. 

Note. —  Milk  may  be  substituted  for  the  water. 

ALBUMINIZED  ORANGE,  30  CALORIES  i 

White  1  egg.  Sugar. 
Juice  1  orange. 

To  the  unbeaten  white  add  the  orange  juice,  sweeten  to 
taste  and  blend  thoroughly.  Strain  and  set  on  ice  to  cool. 
Serve  cold. 

ALBUMINIZED  SHERRY,  22  CALORIES  i 

White  1  egg.  Sugar. 
%  tablespoon  sherry. 

Beat  the  white  stiff,  add  slowly,  while  beating,  the  wine  and 
sugar.    Serve  cold. 

Note. —  Have  all  ingredients  cold  before  blending. 

ALBUMINIZED  GRAPE  JUICE,  40  CALORIES  i 

2  tablespoons  Welch's  Sugar. 
Grape  Juice.  Chopped  ice. 

White  1  egg. 

Put  in  a  dainty  glass  the  grape  juice,  and  the  beaten  white 
of  egg  and  a  little  pure  chopped  ice;  sprinkle  sugar  over  the 
top  and  serve. 

^Without  sugar. 


124 


BEVERAGES 


STARCHY  BEVERAGES 

Starchy  drinks  consist  of  cereals  or  cereal  products,  cooked 
thoroughly  in  a  large  amount  of  water  and  strained  before 
serving.  Arrowroot,  cornstarch,  tapioca,  rice  and  rice  flour 
are  nearly  pure  starch.  Oats,  barley  and  wheat  in  forms 
which  include  the  whole  grains  contain  besides  starch  some 
protein  and  fat,  and  also  valuable  mineral  matter,  especially 
phosphorus,  iron,  and  calcium  salts.^  In  starchy  drinks, 
these  ingredients  are  necessarily  present  in  small  amounts; 
hence  they  have  little  energy  value,  unless  milk  or  other 
highly  nutritive  material  is  added.  Such  drinks  are  of  value 
when  only  a  small  quantity  of  nutriment  can  be  taken. 

Principles  of  Cooking.  As  the  chief  ingredient  is  starch, 
long  cooking  is  necessary,  in  water  at  a  high  temperature 
(212°  F.),  which  softens  the  cellulose,  and  breaks  open  the 
starch  grains,  changing  the  insoluble  starch  to  soluble  starch 
and  dextrin,  so  that  it  can  be  very  readily  digested.  Time 
of  cooking  should  be  conscientiously  kept  by  the  clock. 

Digestion.  The  action  of  ptyalin  is  very  rapid,  and  if  these 
drinks  are  sipped  slowly,  so  as  to  be  thoroughly  mixed  with 
saliva,  a  considerable  portion  of  starch  may  be  changed  to 
sugar  before  reaching  the  intestines. 

BARLEY  WATER,  180  CALORIES 

2  tablespoons  pearl  barley.  1  quart  cold  water. 

Wash  barley,  add  cold  water  and  let  soak  several  hours  or 
over  night;  in  same  water,  boil  gently  over  direct  heat  two 
hours,  or  in  a  double  boiler  steadily  four  hours,  down  to  one 
pint  if  used  for  infant  feeding,  and  to  one  cup  for  the  adult. 
Strain  through  muslin. 

Note. —  Cream  or  milk  and  salt  may  be  added,  or  lemon 
juice  and  sugar.  Barley  water  is  an  astringent  or  demulcent 
drink  used  to  reduce  laxative  condition. 

^See  Mineral  Matter,  p.  31. 


STARCHY  BEVERAGES 


125 


BARLEY  WATER  (INFANT  FEEDING),  19  CALORIES 

1  teaspoon  barley  flour.  1  pint  boiling  water. 

2  tablespoons  cold  water. 

Blend  flour  and  cold  water  to  a  smooth  paste  in  top  of 
double  boiler;  add  gradually  the  boiling  water.  Boil  over 
direct  heat  five  minutes^  stirring  constantly^  then  put  over 
boiling  water  and  cook  15  minutes  longer,  stirring  frequently. 
Older  infants  take  the  barley  water  in  much  more  concentrated 
form.  Barley  water  is  used  as  a  diluent  with  normal  infants 
and  in  forms  of  diarrhoea. 

Kote. —  For  children  or  adults,  use  ^  tablespoon  barley  or 
rice  flour,  1  cup  boiling  water,  ^4  teaspoon  salt. 

RICE  WATER,  100  CALORIES  i 

2  tablespoons  rice.  Salt. 

3  cups  cold  water.  Milk. 

Wash  the  rice;  add  cold  water  and  soak  thirty  minutes, 
heat  gradually  to  boiling  point  and  cook  one  hour  or  until 
rice  is  tender.  Strain,  reheat  and  dilute  with  boiling  water 
or  hot  milk  to  desired  consistency.    Season  with  salt. 

Note. —  Sugar  may  be  added  if  desired,  and  cinnamon,  if 
allowed,  may  be  cooked  with  it,  and  wdll  assist  in  reducing  a 
laxative  condition. 

RICE  WATER  NO.  II,  160  CALORIES 

3  tablespoons  rice.  1  tablespoon  stoned  raisins.  • 

1  pint  boiling  water. 

Wash  rice,  put  into  saucepan  with  water  and  raisins;  boil 
gently  for  one  hour.  Strain.  When  cold  serve.  Sugar  or 
salt  may  be  added  to  taste. 

Isote. —  Do  not  use  raisins  in  bowel  trouble. 

OATMEAL  WATER,  50  CALORIES 

1  tablespoon  oatmeal.  Speck  salt. 

1  tablespoon  cold  water.  1  quart  boiling  water. 

Mix  oatmeal  and  cold  water,  add  salt  and  stir  into  the 
boiling  water.    Boil  three  hours:  replenish  the  water  as  it 

1  Without  milk. 


126 


BEVERAGES 


boils  away.  Strain  through  a  fine  sieve  or  cheese  cloth. 
Season^  serve  cold.  Different  brands  of  oatmeal  vary  consid- 
erably in  the  amount  of  water  which  they  take  up  in  cooking, 
and  sufficient  should  always  be  added  to  make  this  drink  al- 
most as  thin  as  water. 

OATMEAL  WATER  NO.  II,  220  CALORIES  i 

V2  cup  fine  oatmeal.  1  quart  water. 

Use  sterile  water  (boiled  and  cooled).  Add  oatmeal  and 
stand  in  warm  place  (covered),  for  one  and  one-half  hours. 
Strain,  season,  and  cool.    Sometimes  used  for  dyspeptics. 

TOAST  WATER,  350  CALORIES 

1  cup  stale  bread  toasted.  Salt. 
1  cup  boiling  water. 

Cut  bread  in  thin  slices  and  in  inch  squares.  Dry  thor- 
oughly in  oven  until  crisp  and  a  delicate  brown.  Measure, 
and  break  into  crumbs;  add  the  water  and  let  it  stand  one 
hour.  Eub  through  a  fine  strainer,  season  and  serve  hot  or 
cold.  The  nourishment  of  the  bread  is  easily  absorbed  in 
this  way  and  valuable  in  cases  of  fever  or  extreme  nausea. 

Note. —  Milk  or  cream  and  sugar  may  be  added. 

CRTJST  COFFEE 

Take  some  pieces  and  crusts  of  brown  bread  and  dry  them 
in  a  slow  oven  until  thoroughly  hard  and  crisp.  Place  in  a 
mortar  and  pound  or  roll.  Pour  boiling  w^ater  over  and  let 
soak  for  about  fifteen  minutes.  This  when  strained  carefully 
is  very  acceptable  to  invalids  who  are  tired  of  the  ordinary 
drinks,  such  as  lemonade,  etc. 

CRACKER  PANADA,  100  CALORIES  2 

4  hard  crackers.  Sugar. 
1  quart  water. 

Break  crackers  into  pieces  and  bake  quite  brown ;  add  water 
and  boil  fifteen  minutes,  allow  to  stand  three  or  four  minutes. 
Strain  off  the  liquid  through  a  fine  wire  sieve ;  season  with  salt 


^  Estimated  on  one-half  the  oatmeal. 
2  Without  sugar. 


MISCELLANEOUS  BEVERAGES  127 


and  a  little  sugar.  This  is  a  nourishing  beverage  for  infants 
that  are  teething,  and  with  the  addition  of  a  little  wine  and 
nutmegs  is  often  prescribed  for  invalids  recovering  from  a 
fever. 

BREAD  PANADA,  162  CALORIES 

11/2  cups  water.  %  cup  white  wine. 

1  tablespoon  sugar.  1  tablespoon  lemon  juice. 

2  tablespoons  stale  white  bread  Nutmeg, 
crumbs. 

Put  water  and  sugar  on  to  cook,  just  before  it  commences 
to  boil  add  the  bread  crumbs;  stir  well,  and  let  it  boil  three 
or  four  minutes.  Add  the  wine,  lemon  and  a  grating  of  nut- 
meg ;  let  it  boil  up  once,  remove  from  fire,  and  keep  it  closely 
covered  until  it  is  wanted  for  use. 

MISCELLANEOUS  BEVERAGES 

TEA  —  COFFEE —CHOCOLATE  —  COCOA  AND  SPECIAL  NON-NTJ- 
TRITIVE  BEVERAGES 
TEA 

Source,  The  tea  of  commerce  is  prepared  from  the  leaves 
of  a  shrub  cultivated  for  this  purpose  in  China,  Japan,  India, 
Ceylon,  and  other  portions  of  Southern  and  Eastern  Asia. 

Classes  of  Tea,  There  are  two  great  classes  of  tea,  the 
green  and  the  black.  The  difference  lies  in  the  mode  of 
preparation.  Green  teas  are  quickly  dried  and  fired;  black 
teas  are  allowed  to  ferment  a  few  hours  before  drying  and 
firing. 

Active  Principles  of  Tea.  Tea  has  practically  no  food 
value.  Its  principal  constituents  are  caffein,  tannic  acid,  and 
a  volatile  oil. 

Its  flavor  is  due  to  the  volatile  oil;  its  stimulating  prop- 
erties to  the  caffein.  Tannic  acid  is  a  soluble,  bitter  sub- 
stance, which  has  a  retarding  effect  on  digestion. 

When  tea  leaves  are  placed  in  boiling  water,  caffein  is  ex- 
tracted very  rapidly.  Tannic  acid  is  less  soluble,  and  there- 
fore it  is  possible  to  make  tea  with  little  of  this  principle  by 
letting  the  water  stand  on  the  leaves  only  a  short  time.  In 


128 


BEVERAGES 


practice^  the  hot,  but  not  boiling  water,  should  stand  on  the 
tea  from  3  to  5  minutes.  The  water  should  be  soft,  as 
lime  in  hard  water  tends  to  make  tannin  dissolve  more  freely. 
Green  or  mixed  tea  is  more  powerful  than  black  tea. 

Effects  of  Tea.  Tea  is  mildly  stimulating  and  hence  re- 
freshing, as  it  removes  the  sense  of  bodily  fatigue.  But  the 
tannic  acid  retards  the  digestive  action  of  the  saliva  and  gas- 
tric juice,  and  tends  to  produce  constipation.  Tea  is  there- 
fore not  suitable  for  persons  suffering  from  gastric  disorders. 
The  caffein  is  over-stimulating  to  the  nervous  system  of 
many  persons,  causing  restlessness,  sleeplessness  and  muscular 
tremors.  It  should  not  be  given  to  children,  nor  to  adults 
with  a  tendency  to  nervousness.  If  you  wish  to  avoid  the 
retarding  effect  of  tea  on  salivary  digestion,  direct  the  patient 
not  to  sip  the  beverage  with  the  meal,  but  to  eat  first  and 
drink  afterward;  in  this  way  time  is  given  for  the  saliva 
to  perform  its  intended  functions. 

Tea  is  less  likely  to  cause  sleeplessness  if  lemon  juice  is 
substituted  for  milk. 

COFFEE 

Source.  This  beverage  is  prepared  from  the  seeds  of  the 
coffee  tree  (Caffea  arabica),  which  grows  in  many  warm 
countries,  though  originally  found  in  Arabia.  The  coffee 
berry  is  about  the  color  and  size  of  a  ripe  cherry,  and  con- 
tains two  seeds  placed  face  to  face. 

Active  Principles  of  Coffee.  The  active  principles  of  cof- 
fee are  essentially  the  same  as  those  in  tea.  By  the  roasting 
process  a  volatile  oil  is  liberated  (called  caffeol)  to  which  the 
aroma  is  due.  The  caffein  is  chemically  the  same  as  in  tea, 
and  according  to  Hutchison  (p.  310),  a  cup  of  black  coffee 
contains  about  as  large  a  quantity  of  caffein  and  tannic  acid 
as  a  cup  of  tea. 

Effects  of  Coffee.  Coffee  has  only  a  slight  retarding  in- 
fluence on  salivary  digestion,  compared  Avith  tea,  but  an 
equally  detrimental  effect  on  gastric  digestion. 

As  a  stimulant  it  effects  more  directly  the  central  nervous 


MISCELLANEOUS  BEVERAGES  129 


system;  the  heart  action  is  considerably  increased  in  rate 
as  well  as  strength.  Indirectly,  this  results  in  an  increased 
activity  of  the  kidneys.  The  respiration  is  deepened  and  the 
cerebral  centers  excited.  For  this  reason  it  often  proves  use- 
ful in  cases  of  opium  and  alcoholic  poisoning.  In  some  per- 
sons these  effects  are  very  mild  ;  in  others,  they  are  severe, 
producing  nervousness  and  insomnia,  and  coffee  should  be 
withheld.  It  removes  the  sensation  of  fatigue,  for  which 
reason  it  is  used  by  many  nurses  when  on  night  duty.  It 
should  never  be  given  to  children. 

Coffee  or  tea  taken  with  either  milk  or  sugar  alone  is  much 
more  healthful  and  less  likely  to  cause  ill  effects  than  when 
both  are  used. 

Frequently  after  operation  freshly  made  black  coffee  or 
tea  without  milk  or  sugar  will  be  retained,  and  in  some  cases 
check  vomiting.  Give  the  patient  one-half  teaspoonful  at 
frequent  intervals. 

Many  preparations  have  been  put  upon  the  market  as 
coffee  substitutes,  but  they  lack  the  aromatic  oil  and  caffein 
for  which  it  is  really  prized.  They  make,  however,  pleasing 
hot  beverages,  and  served  with  sugar  and  cream,  have  a  food 
value. 

CHOCOLATE  AND  COCOA 

Source.  Cocoa  and  chocolate  are  commercially  prepared 
from  the  seeds  of  the  cocao  tree,  Theobroma  cocao.  The  seeds 
(or  beans)  are  contained  in  a  pulpy  fruit  7-13  inches  long, 
3-5  inches  in  diameter,  in  shape  intermediate  between  a  melon 
and  a  cucumber.  The  fruit  is  gathered  and  allowed  to  re- 
main in  a  heap  to  ferment  a  few  days,  when  the  pulp  becomes 
loosened.  The  seeds  lose  some  of  their  bitterness  during  this 
process,  upon  which  the  flavor  of  the  bean  largely  depends. 
They  are  then  dried  in  the  sun,  cleaned  and  sorted,  and  care- 
fully roasted.  After  this  the  thin  outer  husks  are  removed 
and  sold  under  the  name  of  cocoa  shells.  The  broken  roasted 
beans  constitute  cocoa  nibs. 

Chocolate  is  prepared  by  grinding  the  nibs  between  hot 
rollers  to  a  great  degree  of  fineness.    The  presence  of  50  per 


130 


BEVERAGES 


cent,  fat  causes  the  mass  to  form  a  paste.  This  is  molded 
and  cooled  with  or  without  the  addition  of  sugar  and  flavor- 
ing. 

Cocoa  consists  of  chocolate  deprived  of  a  part  of  the  fat. 
Sugar  or  starch  or  both,  are  sometimes  added. 

Resemblance  to  Tea  and  Coffee.  Chocolate  and  cocoa  con- 
tain a  volatile  oil,  set  free  by  the  fermentation  process  and 
further  modified  by  roasting,  to  which  the  characteristic 
flavor  is  due.  They  also  contain  tannic  acid,  but  in  smaller 
amount  than  in  tea  or  coffee.  The  stimulating  principle 
of  chocolate  and  cocoa  is  an  alkaloid  closely  allied  to  caffein, 
called  theobromin.  It  is  less  apt  to  induce  nervous  symptoms 
than  either  tea  or  coffee,  but  in  many  persons  their  stimulat- 
ing power  is  distinctly  felt. 

Nutritive  Value.  Unlike  tea  and  coffee,  chocolate  and  co- 
coa have  a  high  food  value,  as  shown  by  the  following 
analysis : 

Protein         Fat         Carbo-    Mineral        Water  Calories 
hydrates    Matter  per  lb. 

Chocolate    12.5%        47.1%        26.8%        3.3%        10.3%  2720 

Breakfast  Cocoa    21.6%        28.9%        37.7%        7.2%  4.6%  2320 

By  reason  of  the  high  percentage  of  fat,  chocolate  is  likely 
to  cause  indigestion  when  used  to  excess,  or  when  taken  in 
addition  to  an  otherwise  heavy  meal.  Cocoa,  being  less  rich 
in  fat,  is  free  from  this  objection. 

The  use  of  cocoa  often  makes  milk  acceptable  when  it 
would  otherwise  be  refused.  Hence  this  beverage  is  good 
in  convalescence,  if  there  are  no  digestive  disturbances.  When 
made  weak,  it  can  also  be  given  to  children  in  moderation. 

Principles  of  CooTcing.  Chocolate  and  cocoa  both  contain 
considerable  starch,  and  hence  should  be  boiled  to  be  di- 
gestible. The  cooked  starch  also  serves  to  thicken  the  bev- 
erage somewhat,  and  to  make  it  smoother  and  more  homo- 
geneous. On  account  of  the  volatile  oil  to  which  the  flavor 
is  due,  the  cooking  should  be  continued  only  long  enough  to 
alter  the  starch,  otherwise  the  oil  is  lost. 


MISCELLANEOUS  BEY  EE  AGES  131 


TEA 

(Individual  Rule.) 
1  teaspoon  tea.  1  cup  boiling  water. 

Scald  the  teapot,  which  should  be  silver,  crockery  or  granite 
ware,  not  tin.  Put  in  the  tea,  add  the  freshly  boiling  water 
and  let  it  infuse  three  to  five  minutes.  By  no  means  allow 
it  to  boil,  for  boiling  dissipates  the  aroma  and  extracts  the 
tannin.  Strain  into  hot  cup  and  serve  with  cream  or  milk 
and  lump  sugar,  or  with  sugar  and  a  slice  of  lemon. 

RUSSIAN  TEA 

Heat  cup,  fill  three-fourths  full  of  boiling  water  and  dip  in 
it  two  teaspoons  tea  (put  in  tea-ball  or  fine  small  strainer), 
until  strong  enough.  Serve  hot  with  sugar  and  a  slice  of 
lemon. 

Note. —  Lemon  is  a  good  substitute  for  milk.  The  lemon 
prevents  the  headache  and  sleeplessness  which  the  milk  in 
tea  causes  to  some  persons. 

COFFEE  MADE  IN  THE  PERCOLATER 

Breakfast  Coffee.  After-Dinner  Coffee. 

2  tablespoons  coffee.  Increase   quantity   of  coffee  to 

1  cup  cold  water.  suit  the  taste. 

From  the  percolator  take  out  the  cup  with  its  tube,  fill  the 
percolator  with  the  quantity  of  water  desired,  replace  cup  and 
tube  (covering  tube  with  thumb),  and  put  in  the  coffee,  then 
put  on  the  spreader  plate  and  cover.    Cook  fifteen  minutes. 

Note. —  If  warm  or  hot  water  is  used  it  takes  less  time  for 
cooking.  Never  use  boiling  water.  It  takes  a  little  longer 
with  the  urns  than  with  the  pots. 

When  heat  is  applied  to  the  foot  of  the  pot,  a  jet  of  water 
lukewarm  at  first,  but  quickly  increasing  in  temperature  as 
the  pumping  process  goes  on,  is  forced  up  through  the  tube, 
falls  on  the  spreader  plate;  by  it,  it  is  evenly  distributed  over 
the  coffee,  through  which  it  percolates  down  into  the  pot 
again.  This  pumping  continues  until  the  water  reaches  the 
boiling  point,  when  water  and  steam  together  come  up 
through_the  tube.    The  coffee  is  thus  ready  to  serve. 


132 


BEVERAGES 


Coffee  made  in  this  way  has  a  delicious  aroma,  a  fine  flavor 
and  an  absence  of  the  bitter  taste  caused  by  boiling.  Many 
can  drink  coffee  made  in  this  way  that  cannot  when  made 
in  other  ways. 

Buy  coffee  in  the  berry  and  grind  it  fresh  every  day,  for 
ground  coffee  soon  loses  its  aroma. 

BOILED  COFFEE 

(To  make  seven  cups  of  coffee.) 

1  cup  cofTee.  6  cups  boiling  water. 
%  egg  and  shell.                  •        1  cup  cold  water. 

Scald  coffee  pot.  Wash  egg,  beat  slightly  and  add  crushed 
shell,  coffee  and  one-half  cup  cold  water.  Put  into  scalded 
coffee  pot,  add  boiling  water  and  let  boil  up  three  times, 
stirring  down  after  each  time  (or  boil  five  minutes)  ;  then 
add  one-half  cup  cold  water.  Let  it  stand  20  minutes  where 
it  will  keep  hot  but  not  boil.  Serve  in  hot  coffee  cups  with 
cream  and  sugar,  or  hot  milk  may  be  used  in  place  of  cream. 

Note. —  A  favorite  blend  of  coffee  is  three  parts  Java  and 
one  part  Mocha. 

BOILED  COFFEE 

(Individual  Rule.) 

2  tablespoons  coffee.  %  cup  boiling  water. 

1  egg  shell  or  1  teaspoon  ^^  cup  cold  water, 
egg  white. 

Follow  general  directions  for  blending  in  preceding  recipe. 
Boil  three  minutes  and  keep  hot  15  minutes. 

For  the  Diabetic.  The  following  varieties  may  be  used. 
Pour  coffee  into  a  slightly  beaten  egg  or  yolk ;  or  one  teaspoon 
butter;  or  heavy  cream.    Substitute  Sweetina  for  sugar. 

FILTERED  COFFEE 

(Individual  Rule.) 

2  tablespoons  finely  ground  %  cup  boiling  water. 

coffee. 

Place  a  piece  of  filter  paper  over  a  strainer  and  put  the 
coffee  in  it.  Hold  the  strainer  over  a  hot  coffee  cup  and  pour 
the  boiling  water  slowly  over  the  coffee. 


MISCELLANEOUS  BEVERAGES  133 


FILTERED  COFFEE  NO.  II 

(Individual  Rule.) 

2  tablespoons  coffee.  1  cup  boiling  water. 

Grind  the  coffee  very  fine^  put  it  into  the  upper  part  of 
a  double  coffee  pot  and  pour  the  boiling  water  through  it. 
Let  it  stand  a  few  minutes  on  the  back  of  the  stove,  where 
it  will  not  boil.    Then  remove  it  and  serve  hot. 

MALTED  MILK  COFFEE,  59  CALORIES  i 

(Individual  Rule.) 
1    tablespoon   Horlick's   Malted  %  cup  boiling  water. 

Milk.  Sugar. 
1  tablespoon  ground  coffee. 

Mix  the  malted  milk  powder,  coffee  and  water,  stirring 
well.    Boil  three  minutes.    Add  sugar  if  desired. 

Or  one  to  four  teaspoons  of  malted  milk  powder  may  be 
put  in  a  cup  and  ordinary  coffee  poured  directly  upon  it, 
stirring  constantly. 

CEREAL  COFFEE 

(Two  Cups.) 

4  tablespoons  cereal  coffee.  %  saltspoon  butter. 

1  pint  cold  water. 

Put  the  cereal  into  coffee  pot;  add  cold  water  and  butter, 
when  it  reaches  the  boiling  point,  boil  15  minutes.  Al- 
ways allow  25  minutes  to  make  cereal  coffee;  10  minutes  to 
come  to  the  boiling  point  and  15  minutes  for  the  boiling 
(not  violent  boiling).  Serve  with  sugar  and  hot  milk  or 
cream. 

Note. —  As  cereal  coffee  is  made  of  browned  grain,  it  is  a 
wholesome  drink,  and  is  not  stimulating.  Butter  is  added  to 
keep  the  coffee  from  boiling  over. 

BREAKFAST  COCOA,  957  CALORIES 

(To  make  six  cups  of  cocoa.) 

3  tablespoons    Walter    Baker's  1  cup  boiling  water, 
cocoa.  3  cups  scalded  milk. 

4  tablespoons  sugar. 

1  Without  sugar. 


134 


BEVERAGES 


Scald  milk  in  double  boiler.  Put  the  cocoa  and  sugar  in 
a  saucepan  and  slowly  pour  on  the  hot  water,  stirring  all  the 
time.  Boil  five  minutes,  add  the  scalded  milk,  beat  until 
foamy  with  Dover  egg  beater  to  prevent  formation  of  skin. 
Serve  in  heated  cups.  One-half  cup  of  cream  is  a  great  addi- 
tion to  cocoa. 

BREAKFAST  COCOA,  197  CALORIES 

(Individual  Rule.) 
2  teaspoons  Walter  Baker's    ,       %  cup  boiling  water. 

cocoa.  %  cup  scalded  milk. 

1  teaspoon  sugar. 

Follow  general  directions  for  blending  and  cooking  in  pre- 
ceding recipe.    Boiling  three  minutes. 

Note. —  Cocoa  may  be  served  hot  or  ice  cold,  with  or  with- 
out whipped  cream.  It  may  be  served  hot,  poured  over  the 
beaten  white  or  yolk  of  egg.  One-third  teaspoon  of  brandy 
may  be  added  if  ordered  by  the  physician. 

MALTED  MILK  COCOA,  83  CALORIES  i 

(Individual  Rule.) 
1  tablespoon  Horlick's  Malted       %  cup  boiling  water. 

Milk.  Sugar. 
1  teaspoon  cocoa. 

Mix  the  malted  milk  powder,  cocoa  and  water,  stirring  well. 
Boil  three  minutes.    Add  sugar  if  desired  and  serve  hot. 

PLAIN  CHOCOLATE,  1220  CALORIES 

(Eight  Cups.) 

1  quart  milk.  %  tablespoon  cornstarch. 

2  ounces  Walter  Baker's  choco-  3  tablespoons  sugar, 
late.  Speck  salt. 

2  tablespoons  boiling  water. 

Mix  the  cornstarch  with  one-fourth  cup  of  the  milk.  Put 
remainder  of  milk  in  double  boiler  to  heat.  When  the  milk 
is  scalded,  stir  in  the  cornstarch  and  cook  ten  minutes. 
Scrape  the  chocolate  and  put  it  in  a  small  saucepan;  add 
sugar  and  water  and  place  the  saucepan  over  hot  water.  Stir 

1  Without  sugar. 


MISCELLANEOUS  BEVERAGES  135 


constantly  until  the  mixture  is  smooth  and  glossy.  Add  the 
hot  milk  and  beat  the  mixture  with  egg  beater  until  frothy; 
or  it  may  be  poured  back  and  forth  from  the  boiler  to  a 
pitcher,  holding  high  the  vessel  from  which  it  is  poured. 
This  will  give  a  thick  froth.    Serve  at  once. 

Note. —  If  you  prefer  not  to  thicken  the  chocolate,  omit 
the  cornstarch. 

^Tiipped  cream  may  be  served  with  chocolate,  or  it  may 
be  poured  onto  the  beaten  yolk  of  egg. 

If  desired,  flavor  with  one-half  teaspoon  vanilla. 

PLAIN  CHOCOLATE,  305  CALORIES 

(Individual  Rule.) 
1  cup  milk.  %  tablespoon  cornstarch. 

Y2  ounce  chocolate.  %  tablespoon  sugar. 

Following  directions  for  blending  and  cooking  in  preced- 
ing recipe. 

CHOCOLATE,  VIENNA  STYLE,  1427  CALORIES 

(Eight  Cups.) 

1  quart  milk.  3  tablespoons  boiling  water. 
4  ounces  Walter  Baker's  vanilla  1  tablespoon  sugar. 

chocolate. 

Scald  milk  in  double  boiler.  Scrape  chocolate  and  put 
sugar  and  water  into  a  small  saucepan;  heat  over  hot  water^ 
stirring  till  smooth  and  glossy.  Stir  this  mixture  into  the 
hot  milk  and  beat  well  with  an  egg  beater.  Serve  at  once, 
putting  a  tablespoon  of  whipped  cream  in  each  cup^  and 
filling  with  the  chocolate. 

The  plain  chocolate  may  be  used  instead  of  the  vanilla, 
but  in  that  case  use  one  teaspoon  vanilla  and  three  generous 
tablespoons  sugar. 

CHOCOLATE  MILK  SHAKE,  295  CALORIES 

(Individual  Rule.) 

2  tablespoons  chopped  ice.  cup  milk. 

2  tablespoons  chocolate  syrup.  cup  soda  water  or  Apollinaris 

3  tablespoons  whipped  cream.  water. 


136 


BEVERAGES 


Shake  or  stir  well  before  drinking.  A  tablespoon  of 
vanilla  ice-cream  is  a  desirable  addition.  It  is  a  delicious 
drink,  even  if  the  soda  or  Apollinaris  water  be  omitted. 

A  plainer  drink  is  made  by  combining  the  syrup,  three- 
fourths  cup  milk  and  the  ice,  and  shaking  well. 

CHOCOLATE  SYRUP  —  USED  IN  PRECEDING,  2093  CALORIES 

(One  Tablespoon  =:  65  Calories.) 
1  ounce  (3  tablespoons)   Walter  1  tablespoon  vanilla. 

Baker's  soluble  chocolate.  2  cups  sugar. 

1  cup  boiling  water. 

Put  chocolate  in  a  saucepan  and  add  the  water  gradually, 
stirring  all  the  time.  Add  sugar  and  stir  till  it  begins  to 
boil;  boil  three  minutes,  strain,  cool  and  add  one  tablespoon 
vanilla.    Bottle,  and  keep  in  a  cold  place. 

SPECIAL  NOH-NUTRITIVE  BEVERAGES 

FLAXSEED  TEA 

1  tablespoon  whole  flaxseed.         Lemon  juice  to  taste. 

2  cups  cold  water.  Sugar. 

Wash  flaxseed  thoroughly,  put  it  with  the  cold  water  in  a 
saucepan,  simmer  one  hour,  add  lemon  juice  and  sugar  to 
taste  and  strain. 

ISTote. —  If  too  thick,  add  hot  water. 

Valuable  in  case  of  inflammation  of  the  mucous  membrane. 

CINNAMON  WATER 

1  ounce  stick  cinnamon.  1  pint  boiling  water. 

Boil  together  flfteen  minutes.    Strain.    Serve  hot  or  cold. 

Note. —  Good  in  bowel  trouble.  The  pure  cinnamon  is 
quite  different  from  the  coarse  bark  usually  sold  for  cinna- 
mon, which  is  really  only  cassia. 

FLAXSEED  AND  LICORICE  TEA 


1  ounce  flaxseed. 

2  drachms  licorice  root. 


1  pint  boiling  water. 


NON-NUTRITIVE  BEVERAGES 


137 


Pour  the  boiling  water  over  whole  flaxseed  and  bruised 
licorice-root,  cover  and  cook  very'  slowly  for  four  hours. 
Strain. 

LIME  WATER 

1  tablespoon  of  slaked  lime.  1  quart  boiled  or  distilled  water. 

Put  the  lime  and  water  in  a  corked  bottle  and  shake  thor- 
oughly two  or  three  times  during  the  first  hour.  The  lime 
should  then  be  allowed  to  settle,  and  after  twenty-four  hours 
the  upper  clear  fluid  carefully  poured  or  siphoned  off  into 
a  glass-stoppered  bottle.  Keep  tightly  corked,  as  it  absorbs 
carbon  dioxide  from  the  air.    Keep  in  a  cool  place. 

BRAN  TEA 
%  cup  wheat  bran.  Egg  shell. 

2  cups  cold  water.  Molasses,  lemon  juice. 

Boil  the  water  and  bran  twenty  minutes,  and  settle  it  with 
an  egg  shell  or  a  little  cold  water.  Sweeten  with  molasses, 
and  lemon  juice  can  be  used  if  desired. 

SLIPPERY  ELM  TEA 

2  teaspoons  slippery  elm  pow-  Sugar. 

der  or  piece  of  the  bark.  Lemon  juice. 

1  cup  boiling  water. 

Pour  the  water  upon  the  slippery-elm  powder  or  bark. 
When  cool,  strain  and  flavor  with  lemon  juice  and  sugar. 
This  is  soothing  in  case  of  inflammation  of  the  mucous  mem- 
brane. 

HERB  TEA 

Pour  one  cup  of  boiling  water  over  two  tablespoons  of 
herbs.  Cover  the  bowl,  set  it  over  the  tea-kettle  and  steep 
ten  minutes.    Sweeten  if  desired. 

GINGER  TEA 

Mix  one  tablespoon  of  molasses  with  one-half  teaspoon  of 
ginger;  pour  on  gradually  one-half  cup  boiling  water,  and 
boil  one  minute.  Add  one-half  cup  milk  and  when  thor- 
oughly heated,  serve. 


CHAPTER  IX 


ANIMAL  FOODS 

The  important  foods  derived  from  the  animal  kingdom  are 

—  Meat  —  Poultry  and  Game  —  Fish  —  Shell  Pish  —  Eggs 

—  Milk  and  Milk  Products  —  Sweetbreads  —  Gelatin  —  Beef 
Preparations  —  Meat  Broth  and  Jellies. 

Composition,  Milk  is  the  only  animal  food  in  which  all 
the  nutrients  are  represented  in  forms  and  proportions  suit- 
able to  supply  all  the  needs  of  the  body.  It  is  properly  called 
a  "  complete  food.''  Eggs,  also  often  called  complete  food/' 
contain  both  body-building  and  fuel  food-stuffs,  but  are  in- 
complete in  the  sense  that  the  amount  of  carbohydrate  is  so 
small  as  to  be  almost  negligible. 

Meats  are  valuable  primarily  as  sources  of  protein.  When 
fat  is  present  they  are  also  useful  for  fuel. 

Meat  extracts  are  chiefly  valuable  for  their  flavor  and  stim- 
ulating properties. 

The  Proteins  of  animal  foods  are  of  many  forms,  con- 
spicuous among  which  are  albumin  of  egg-white;  myosin  of 
muscle;  casein  of  milk;  fibrin  of  blood;  nucleo-protein  of 
liver  and  sweetbreads;  collagen  of  connective  tissue. 

The  Fats  are  chiefly  mixtures  of  stearin,  palmitin  and  olein 
in  varying  proportions;  small  amounts  of  esters  of  volatile 
fatty  acids;  and  compounds  of  fats  with  phosphorus  in  the 
form  of  lecithin  and  related  substances. 

Extractives.  Nitrogenous  extractives  are  found  chiefly  in 
meat,  to  which  they  help  to  give  the  characteristic  flavor  and 
the  stimulating  properties.  They  consist  chiefly  of  purins 
(adenine,  guanine,  xanthine,  hypoxanthine  and  uric  acid)  ; 
and  creatin  and  creatinin. 

Carbohydrates.    The  carbohydrates  are  represented  mainly 

138 


ANIMAL  FOODS 


139 


by  lactose  in  milk,  and  glycogen  in  shellfish.  As  a  rule,  carbo- 
hydrates are  negligible  in  animal  foods. 

Water.  AYater  is  present  in  all  animal  foods.  Some  ex- 
amples, showing  the  varying  proportions  in  different  kinds, 
are  given  in  the  following  table : 


Mineral  Matter.  Milk  and  eggs  are  more  valuable  for  their 
ash  constituents  than  any  other  animal  foods.  Calcium,  iron 
and  phosphorus  especially,  are  here  found  in  most  available 
forms. 

Meats  are  not  particularly  useful  in  this  respect.  They 
are  deficient  in  calcium,  and  while  they  contain  considerable 
iron,  it  is  not  in  as  useful  a  form  as  that  in  eggs.  Most  of 
the  ash  constituents  found  in  the  body  are,  however,  repre- 
sented in  flesh  foods. 

Digestibility,  As  a  class,  animal  foods  are  easy  of  diges- 
tion. They  contain  little  indigestible  residue,  and  the  nu- 
trients are  very  perfectly  absorbed.  Prepared  for  the  table, 
they  are  more  concentrated  than  most  vegetable  foods.  Hence 
animal  foods  are  frequently  chosen  for  invalids  and  con- 
valescents, regardless  of  their  high  protein  content. 

Disadvantage  of  a  Purely  Animal  Diet.  The  chief  dis- 
advantages of  a  purely  animal  diet  are  that  it  does  not  afford 
sufficient  bulk  to  maintain  the  proper  functioning  of  the 
alimentary  tract,  owing  to  the  lack  of  indigestible  residue; 
and  that  it  loads  the  body  with  an  excess  of  nitrogenous  ma- 
terial, which  is  not  only  unnecessary  for  repair,  but  may 
cause  harm  if  not  speedily  eliminated.  Furthermore,  pro- 
tein raises  the  metabolism  so  that  more  food  is  actually  re- 
quired than  if  carbohydrates  and  fats  are  used  as  fuel.  For 
further  discussion  of  the  relative  merits  of  animal  and  veg- 
etable diets,  see  page  233. 


Lean  beef 
Salt  cod  . 


Oyster  solids 

Milk   

Eggs  


88% 
87% 
73% 
75% 
50% 


140 


ANIMAL  FOODS 


MEAT 

The  term  meat  includes  the  flesh  of  all  animals  used  for 
food,  as  beef,  veal,  mutton,  lamb,  pork,  poultry,  game.  Lean 
meat  is  almost  a  pure  protein  food. 

Composition  of  Meat: 

1.  Muscle  fibers,  composed  of  proteins,  extractives,  in- 

organic salts,  and  water. 

The  principal  protein  is  albumin.  Muscle  al- 
bumin is  often  called  myosin. 

The  extractives  are  largely  nitrogenous. 

The  mineral  constituents  in  greatest  abundance  are 
phosphates  and  potash  salts. 

2.  Connective  tissue  which  binds  together  the  muscle  fibers, 

this  consisting  chiefly  of  a  protein  called  collagen, 
which  yields  gelatin  on  boiling. 

3.  Fat  interspersed  between  the  fibers. 

Nutritive  Value,  Meat  is  rich  in  nitrogenous  elements  and 
fats,  and  contains  important  salts,  chiefly  potassium  and  iron. 
It  is  easily  cooked  and  improves  in  flavor  during  the  process ; 
requires  less  mastication  and  is  more  easily  digested  and  as- 
similated than  most  vegetable  food. 

Meat  is  lacking  in  carbohydrates,  and  unless  a  large  amount 
of  fat  is  present,  is  to  be  regarded  as  a  source  of  nitrogen 
rather  than  of  energy.  Since  protein  burns  up  faster  than 
other  foods,  and  very  little  of  the  nitrogen  can  be  retained  in 
the  body,  it  is  most  advantageously  used  in  small  amounts 
along  with  plenty  of  fats  and  carbohydrates. 

The  most  important  food  element  in  meat  is  the  myosin  or 
muscle  albumin.  The  collagen  belongs  to  a  group  of  proteins 
often  called  gelatinoids  or  albuminoids,  because,  unlike  the 
albumins,  they  cannot  sustain  life  alone.  They  are  able, 
however,  to  replace  other  proteins  to  the  extent  of  two-thirds 
of  the  ordinary  nitrogen  requirement.  In  young  animals,  the 
connective  tissue  is  soft,  and  the  tissues  are  easily  masticated ; 
but  in  older  animals  it  becomes  very  firm,  is  hard  to  chew 


MEAT 


141 


and  often  escapes  digestion  unless  softened  or  changed  to 
gelatin  by  cooking. 

The  nitrogenous  extractives  have  no  nutritive  value,  and 
in  fact,  represent  products  either  of  waste  (katabolism)  or  of 
insufficient  oxidation.  Unless  promptly  excreted,  they  may 
cause  an  excess  of  uric  acid  or  other  disorders.  However, 
they  bestow  upon  cooked  meat  its  characteristic  flavor  and 
odor;  in  the  stomach,  act  as  stimulants  to  the  secretion  of 
gastric  juice;  and  exert  on  the  nervous  system  a  stimulating 
influence  similar  to  that  of  tea  and  coffee. 

Digesiibility  of  Meat.  Meat  is  easily  digested,  the  degree 
of  ease  depending  upon  the  following  conditions:  (1)  The 
age  of  the  animal  when  killed,  with  the  exception  of  veal,  the 
flesh  of  the  young  animal  is  more  easily  digested,  but  less 
nutritious  than  that  of  the  older  one;  (2)  the  time  the  animal 
is  kept  before  cooking;  (3)  the  sex;  (4)  the  care  bestowed  on 
the  animal  during  life;  (5)  the  quantity  of  fat.  Lean  meat 
is  more  easily  digested  than  fat  meat. 

Absorption  of  Meat.  Meat  is  very  readily  absorbed  and 
leaves  little  residue  in  the  intestines ;  only  3  per  cent,  of  meat 
taken  is  lost  in  the  process  of  digestion. 

UncooJced  Meat.  Ordinary  raw  meat  is  not  quite  as  easily 
digested  as  cooked  meat.  Owing  to  color  and  flavor,  it  is  not 
appetizing  and  could  not  be  taken  continuously.  However, 
when  chopped  flne  or  scraped  free  from  connective  tissue,  so 
as  to  be  easily  attacked  by  the  digestive  juices,  it  is  more 
readily  digested  than  cooked  meat. 

Effect  of  Cooking  Meat.  Proper  cooking  makes  meat  more 
digestible,  as  it  softens  the  connective  tissues,  thus  causing  a 
separation  of  the  muscular  flbers,  and  enabling  the  digestive 
juices  to  act  more  advantageously.  The  color  and  flavor  are 
improved.  There  is  a  loss  of  weight  by  evaporation  of  water, 
and  loss  of  mineral  matter  and  some  extractives.  The  loss  of 
water  concentrates  the  nutrients,  and  thus  renders  cooked 
meat  proportionally  more  nutritious  than  raw  meat. 


142 


ANIMAL  FOODS 


Objective  Points  and  Methods  in  Cooking: 

1.  To  retain  the  juice  as  in  baking,  broiling,  boiling  and 
frying. 

2.  To  extract  the  juice  as  in  soups. 

3.  To  extract  and  retain  the  juice  as  in  stews. 

The  Principal  Constituent  of  meat  to  be  considered  in  cook- 
ing is  the  albumin.    Note  page  11,  for  albumin. 

Cooking  of  Meat.  Heat  penetrates  meat  slowly.  At  a  tem- 
perature of  158  degrees  Fahrenheit,  the  meat  assumes  a  gray 
color,  as  a  result  of  the  decomposition  of  the  coloring  matter 
of  the  blood.  At  the  same  time  a  peculiar  odor  of  cooking 
develops,  which  is  due  to  chemical  changes  produced  by  the 
heat. 

At  a  temperature  above  104  degrees  Fahrenheit,  meat  be- 
gins to  lose  weight  from  the  separation  of  water,  which  con- 
tains salts  and  nitrogenous  extractives.  This  process  contin- 
ues as  the  temperature  rises,  except  that  coagulable  proteins 
no  longer  separate  with  the  water. 

Coagulation  of  the  albumin  is  an  important  factor  in  cook- 
ing meat,  and  the  degree  varies  with  the  mode  of  cooking. 

As  broiling  is  the  preferred  way  of  preparing  meat  for  the 
sick  and  convalescent,  it  is  taken  up  in  detail  in  this  chapter. 

Broiling.  In  broiling,  the  meat  is  to  be  cooked  in  its  own 
juices ;  it  is,  therefore,  evident  that  these  must  be  retained  as 
completely  as  possible.  At  first  the  temperature  should  be 
sufficiently  high  quickly  to  coagulate,  and  even  harden  the 
albumin  on  the  outside  surface,  so  as  to  form  a  layer  or  pro- 
tecting coat  over  the  whole ;  then  the  heat  should  be  modified 
so  that  the  interior  will  be  raised  to  a  temperature  that  will 
cook  it  properly  without  loss  of  its  nutritive  properties. 

In  broiling  we  partially  sacrifice  the  outer  layer  of  the 
meat,  to  preserve  the  inner  portion. 

The  time  for  exposure  will  be  different  for  different  kinds 
of  meat.  Beef  and  mutton  require  a  shorter  time  than  lamb, 
chicken  or  game. 

A  piece  of  meat  properly  broiled  swells,  and  when  cut,  the 


MEAT 


143 


liquid  portion  flows  out  readily;  but  if  cooked  too  long  the 
albumin  inside  coagulates  and  the  meat  loses  its  moisture, 
shrinks,  and  becomes  tough. 

Effect  of  Cold  and  Hot  Water  on  Meat.  Cold  water  draws 
out  the  soluble  albumin,  the  extractives  and  some  of  the  salts ; 
thus  in  soups,  broths  and  stews  where  all  the  nutriment  pos- 
sible is  desired  in  the  liquid,  the  meat  is  first  put  into  cold 
water  and  gradually  brought  to  a  higher  temperature. 

Hot  water  or  dry  heat  coagulates  albumin,  and  since  if 
subjected  to  too  high  a  temperature  this  becomes  tough  and 
indigestible,  we  must  note  carefully  the  proper  temperature  of 
cooking.  Often  it  is  necessary  to  sacrifice  a  small  amount 
of  albumin  by  exposing  the  meat  to  a  high  temperature  for 
a  short  time  to  form  a  coating  on  the  meat,  in  order  to  re- 
tain the  rest  of  the  juices  more  effectively,  after  which  the 
connective  tissue  can  be  softened  by  gentle  simmering  for 
several  hours. 

The  Quality  of  Meat  depends  upon  the  age,  sex,  environ- 
ment, care,  feeding  and  time  of  hanging  after  slaughtering. 
It  also  depends  greatly  on  the  cuts  used. 

The  tougher  and  less  expensive  cuts,  if  properly  cooked, 
are  as  nutritious  and  as  easily  digested  as  the  expensive  cuts ; 
however,  tough  meats  take  long,  slow  cooking  to  make  them 
palatable,  and  the  fuel  used  must  be  taken  into  consideration 
in  the  expense.  Tough  meats  are  muscles  which  the  animal 
uses  the  most,  as  the  legs  (especially  the  lower  part),  neck, 
etc.;  they  are  more  highly  flavored  on  account  of  the  freer 
circulation  of  blood  through  these  portions.  Cuts  from  the 
neck  and  shin  are  used  for  soups  and  broths. 

The  tenderer  and  more  expensive  cuts  are  from  the  muscles 
w^hich  the  animal  uses  the  least,  as  the  upper  portion  of  the 
hind  quarter  (rump,  sirloin)  and  fore  ribs.  The  circulation 
of  blood  through  these  portions  is  less  and  they  are  not  as 
juicy  and  well  flavored,  nor  any  more  nutritious  than  tougher 
portions.    These  tenderer  cuts  are  used  for  steaks  and  roasts. 

The  remaining  muscular  portions  of  the  animal  (flank, 
shoulder  and  brisket)  are  not  as  tender  as  the  upper  portion 


144 


ANIMAL  FOODS 


of  the  hind  quarter,  but  just  as  nutritious.  They  need  longer 
cooking  and  are  used  for  stews,  braising  and  pot  roast. 

Internal  Organs  or  Animal  Viscera  used  as  food  are  the 
heart,  tongue,  brain,  kidneys,  liver,  pancreas,  thymus  glands 
and  paunch.  Although  some  are  as  easily  digested  as  most 
muscle  tissue,  they  are  not  as  nutritious,  and  most  of  them 
produce  large  quantities  of  uric  acid. 

The  heart,  liver  and  kidneys,  when  properly  cooked,  are 
not  as  easily  digested  as  other  meats,  on  account  of  their  close 
and  firm  texture,  and  should  be  eaten  only  by  those  of  good 
digestive  powers. 

The  tongue  is  not  very  easily  digested,  for  although  the 
lean  meat  is  tender,  the  fat  is  hard,  and  tends  to  retard  diges- 
tion in  the  stomach. 

The  brain  is  the  most  rapidly  digested  of  meats,  but  a 
very  high  per  cent,  is  of  no  use  to  the  body.  It  is  not  suited 
for  invalid  diet  on  account  of  the  high  fat  content. 

The  paunch  is  the  third  stomach  of  the  ox  and  called  tripe. 
When  properly  cooked  it  is  easily  digested,  but  contains  too 
much  fat  to  give  an  invalid. 

The  pancreas  and  thymus  glands  of  the  calf  or  lamb  are 
sold  under  the  name  of  sweetbreads.  They  are  most  easily 
digested,  but  give  rise  to  uric  acid.  Note  chapter  on  Sweet- 
breads. 

Beef.  Beef,  is  without  doubt,  the  most  valuable  kind  of 
meat ;  it  is  nutritious,  of  excellent  flavor,  and  comparatively 
easy  of  digestion. 

Test  for  Good  Beef.  The  flesh  is  firm  and  fine  grained  in 
texture ;  bright  red  in  color  when  first  cut  and  upon  exposure 
to  air;  looks  juicy  and  well-mottled  and  coated  with  fat,  and 
the  fat  is  of  yellowish  color  and  firm. 

The  best  beef  is  obtained  from  the  steer  of  four  to  six  years 
of  age.  After  killing,  the  animal  should  hang  for  two  to 
three  weeks. 

Veal.  The  fiesh  of  the  calf  is  difficult  of  digestion  and 
should  only  be  used  in  the  sick  room  for  making  broth.  It 
should  never  be  eaten  by  those  of  weak  digestion.    It  con- 


MEAT 


145 


tains  less  albuminous  substances^  and  more  gelatin  than 
beef. 

Test  for  Good  Veal.  It  should  be  of  a  pinkish  color,  with 
clear,  firm,  white  fat,  fine  grained  and  tender.  The  cut  most 
used  for  broth  and  soup  is  the  lower  part  of  the  leg  known 
as  the  knuckle. 

Mutton.  Xext  to  beef,  mutton  is  considered  the  most 
nutritious  of  meats,  and  by  some  considered  as  easily  digested ; 
but  it  is  known  that  fat  of  mutton,  which  consists  largely  of 
stearin,  is  not  as  easily  digested. 

The  best  quality  of  mutton  comes  from  a  sheep  from  three 
to  five  years  old;  after  killing  it  should  be  allowed  to  hang 
to  ripen  and  to  develop  the  flavor. 

Test  for  Good  Mutton.  The  flesh  is  flne  grained,  bright 
pink  in  color,  the  fat  is  white,  hard  and  flaky,  and  the  skin 
comes  off  easily.  The  bones  of  mutton  are  white  and  smooth 
and  round  at  the  joints. 

Lamb.  Lamb  of  the  right  age  is  as  nutritious  as  beef  or 
mutton  but  the  flesh  is  milder  in  flavor. 

Lamb  is  sold  as  spring  lamb  when  killed  at  six  weeks  to 
three  months  old.  It  is  very  expensive  and  comes  into  the 
market  early  in  the  year  —  February  and  March.  Lamb  is 
usually  killed  when  a  year  old,  and  should  be  sold  imme- 
diately after  killing;  in  this  respect  it  differs  from  beef  and 
mutton,  which  should  hang  after  killing  to  ripen  and  develop 
the  flavor. 

Test  for  Lamb.  Lamb  can  be  distinguished  from  mutton 
by  the  pinkish  color  of  the  bone,  and  the  serrated  joints. 

Pork.  The  flesh  of  the  pig  is  the  most  indigestible  of 
all  meats  on  account  of  the  large  percentage  of  fat  which  it 
contains,  consequently  it  is  not  used  in  cookery  for  the  sick, 
except  sometimes  a  small  amount  of  ham,  salt  pork  or  bacon, 
as  the  salty  taste  occasionally  acts  as  a  stimulant  to  the  lost 
appetite  of  the  convalescent.  Ham  and  bacon  are  more  easily 
digested  than  other  cuts  of  pork,  and  when  thin  strips  of 
bacon  are  cooked  crisp  they  are  easily  digested.  Bacon  is 
from  the  flank  of  pork  and  is  salted  and  smoked.    Next  to 


146 


ANIMAL  FOODS 


butter  and  cream,  bacon  fat  is  the  most  easily  assimilated  of 
ordinary  food  fats. 

Cuts  of  Meat.  ^  The  methods  of  cutting  sides  of  beef,  veal, 
mutton,  and  pork  into  parts,  and  the  terms  used  for  the  differ- 
ent "  cuts,^'  as  these  parts  are  commonly  called,  vary  in 
different  localities.  The  diagrams  show  the  positions  of  the 
different  cuts,  both  in  the  live  animal  and  in  the  dressed  car- 
cass, as  found  in  the  markets.  The  lines  of  division  between 
the  different  cuts  will  vary  slightly,  according  to  the  usage  of 
the  local  market,  even  where  the  general  method  of  cutting 
is  as  here  indicated.  The  names  of  the  same  cuts  likewise 
vary  in  different  parts  of  the  country. 


Fig.  5. —  Diagrams  of  cuts  of  beef:  1,  Neck;  2,  chuck;  3,  ribs;  4,  shoul- 
der-clod; 5,  fore-shank;  6,  brisket;  7,  cross-ribs;  8,  plate;  9,  navel;  10,. 
loin;  11,  flank;  12,  rump;  13,  round;  14,  second-cut  round;  15,  hind-shank. 
—  (Atwater  and  Bryant,  Bulletin  No.  28,  Office  of  Experiment  Stations, 
United  States  Department  of  Agriculture.)  Send  for  Bulletin  for  cuts  of 
Veal  and  Pork. 


^  This  section  is  quoted  from  Atwater  and  Bryant,  Bulletin  No.  28,  Office- 
of  Experiment  Stations,  United  States  Department  of  Agriculture,  Washing- 
ton. D.  0. 


Cuts  of  Beef 


Fig.  5 


MEAT 


147 


The  general  method  or  cutting  np  a  side  of  beef  is  illus« 
trated  in  Fig.  5,  which  shows  the  relative  position  of  the  cuts 
in  the  animal  and  in  a  dressed  side.  The  neck  piece  is  fre- 
quently cut  so  as  to  include  more  of  the  chuck  than  is  repre- 
sented by  the  diagrams.  The  shoulder-clod  is  usually  cut 
without  bone,  while  the  shoulder  (not  included  in  diagram) 
would  include  more  or  less  of  the  shoulder  blade  and  of  the 
upper  end  of  the  fore-shank.  Shoulder  steak  is  cut  from  the 
chuck.  In  many  localities  the  plate  is  made  to  include  all 
the  parts  of  the  fore-quarter  designated  on  the  diagrams  as 
brisket,  cross-ribs,  plate,  and  navel,  and  different  portions  of 
the  plate,  as  thus  cut,  are  spoken  of  as  the  brisket  end  of 
plate  and  "  navel  end  of  plate.^'  This  part  of  the  animal  is 
largely  used  for  corning.  The  ribs  are  frequently  divided 
into  first,  second,  and  third  cuts,  the  latter  lying  nearest  the 
chuck  and  being  slightly  less  desirable  than  the  former.  The 
chuck  is  sometimes  sub-divided  in  a  similar  manner,  the  third 
cut  of  the  chuck  being  nearest  the  neck.  The  names  applied 
to  different  portions  of  the  loin  vary  considerably  in  different 
localities.  The  part  nearest  the  ribs  is  frequently  called 
small  end  of  loin  or  short  steak.^^  The  other  end  of  the 
loin  is  called  "  hip  sirloin  or  sirloin.^^  Between  the  short 
steak  and  the  sirloin  is  a  portion  quite  generally  called  the 
"tenderloin,**^  for  the  reason  that  the  real  tenderloin,  the 
very  tender  strip  of  meat  lying  inside  the  loin,  is  found  most 
fully  developed  in  this  cut.  Porterhouse  steak  is  a  term  most 
frequently  applied  either  to  the  short  steak  or  the  tenderloin. 
It  is  not  uncommon  to  find  the  flank  cut  so  as  to  include  more 
of  the  loin  than  is  indicated  in  the  figures,  in  which  case  the 
upper  portion  is  called  "  flank  steak.'^  The  larger  part  of  the 
flank  is,  however^  very  frequently  corned,  as  is  also  the  case 
with  the  rump.  In  some  markets  the  rump  is  cut  so  as  to 
include  a  portion  of  the  loin,  which  is  then  sold  as  rump 
steak.^'  The  portion  of  the  round  on  the  inside  of  the  leg 
is  regarded  as  more  tender  than  that  on  the  outside,  and  is 
frequently  preferred  to  the  latter.  As  the  leg  lies  upon  the 
butcher's  table,  this  inside  of  the  round  is  usually  on  the 


148 


ANIMAL  FOODS 


upper  or  top  side,  and  is  therefore  called  "  top  round/'  Occa- 
sionally the  plate  is  called  the  rattle/' 

Cuts  of  Lamb  and  Mutton 


Fig.  7 

Fig.  7. —  Diagrams  of  cuts  of  lamb  and  mutton:  1,  Neck;  2.  chuck;  3, 
shoulder;  4,  flank;  5,  loin;  6,  leg. —  (Atwater  and  Bryant,  Bulletin  No.  28, 
Office  of  Experiment  Stations,  United  States  Department  of  Agriculture.) 

Fig.  7  shows  the  relative  position  of  the  cuts  in  a  dressed 
side  of  mutton  or  lamb  and  in  a  live  animal.  The  cuts  in  a 
side  of  lamb  and  mutton  number  but  six,  three  in  each  quar- 
ter. The  chuck  includes  the  ribs  as  far  as  the  end  of  the 
shoulder  blades,  beyond  which  comes  the  loin.  The  flank  is 
made  to  include  all  the  under  side  of  the  animal.  Some 
butchers,  however,  make  a  large  number  of  cuts  in  the  fore- 
quarter,  including  a  portion  of  the  cuts  marked  "  loin  and 
chuck  in  Fig.  7,  to  make  a  cut  designated  as  "  rib,'^  and 
a  portion  of  the  "  flank and  "  shoulder to  make  a  cut 
designated  as  ^'  brisket.''  The  term  "  chops "  is  ordinarily 
used  to  designate  portions  of  either  the  loin,  ribs,  chuck  or 
shoulder,  which  are  either  cut  or  "  chopped ''  by  the  butcher 
into  pieces  suitable  for  frying  or  boiling.  The  chuck  and  ribs 
are  sometimes  called  the  "  rack.'' 


MEAT 


149 


ENERGY  VALUE  OF  MEAT 

See  Table,  under  names  of  meat,  as  Beef  —  Mutton  — 
Lamb  —  Bacon  —  Ham,  etc. 

See  Table,  page  64,  for  energy  value  of  other  ingredients. 

TO  BROIL  STEAK 

Wipe,  trim  off  the  superfluous  fat  and  remove  a  little  of 
the  bone.  Save  the  flank  ends  for  broiled  meat  cakes.  Heat 
and  grease  the  broiler  with  some  of  the  fat.  Place  meat  in 
broiler  with  fat  edge  next  to  handle  and  broil  over  a  clear 
fire,  turning  every  ten  seconds  for  the  first  minute,  holding 
broiler  near  the  coals  that  the  surface  may  be  well  seared, 
thus  preventing  escape  of  juices ;  then  cook  at  lower  tempera- 
ture, holding  the  broiler  higher. 

Steak  cut  one  inch  thick  will  take  five  minutes  if  liked 
rare,  and  eight  minutes  if  well  done;  one  and  one-half  inch 
thick,  eight  to  ten  minutes.  Serve  on  a  hot  platter  and  sea- 
son with  butter,  salt  and  pepper,  or  with  Maitre  d'Hotel  But- 
ter. 

Note. —  Steak  should  be  cut  at  least  one  inch  thick ;  many 
prefer  it  much  thicker.  The  most  tender  steaks  are  tender- 
loin, sirloin  and  cross-cut  of  rump.  Sirloin,  porterhouse  (a 
thick  slice  of  sirloin  with  tenderloin  attached),  cross-cut  of 
the  rump  and  top  of  the  round  are  all  good  steaks.  The  top 
of  round  is  solid  meat  and  a  cheap  steak;  is  tender  if  cut 
from  animal  of  right  age  and  is  the  second  or  third  cut  from 
top  of  round. 

MAITRE  D'HOTEL  BUTTER,  443  CALORIES 

^  cup  butter.  1  tablespoon  chopped  parsley. 

%  teaspoon  salt.  1  tablespoon  lemon  juice, 

saltspoon  pepper. 

Eub  the  butter  to  a  cream;  add  salt,  pepper,  parsley  and 
lemon  juice.    Spread  on  hot  beefsteak. 

PAN-BROILED  BEEF  CAKES 

Use  steak  from  upper  part  of  round,  and  with  a  small  piece 
of  suet  put  all  through  a  meat  chopper;  without  seasoning. 


150 


ANIMAL  FOODS 


shape  into  small,  flat,  circular  cakes.  Into  saute  pan  put  a 
little  beef  fat,  when  smoking  hot,  put  in  the  cakes  and  cook 
a  few  moments  on  each  side  and  turn;  it  will  take  about  live 
minutes  to  cook  them.  Season  well  with  salt,  pepper  and 
butter,  and  serve  on  hot  platter.  Do  not  add  salt  before  cook- 
ing, as  it  toughens  the  meat. 

SCRAPED  BEEF 

See  "  Beef  Preparations    for  recipe.    Page  217. 

MUTTON  CHOPS  BROILED  i 

Cut  away  the  tough  outside  skin,  trim  off  a  part  of  the 
fat.  Broil  same  as  steak  —  that  is,  close  to  the  glowing  coals 
—  for  about  one  minute,  turning  every  ten  seconds,  then  cook 
at  a  lower  temperature,  holding  the  broiler  higher.  Will  take 
four  or  six  minutes  for  a  chop  one  inch  thick.  Mutton,  like 
beef,  should  be  served  rare.  Season  chops  with  salt  and 
pepper,  but  not  with  butter,  as  the  meat  is  rich  and  fat  and 
does  not  require  it. 

LAMB  CHOPS  BROILED  1 

Prepare  and  broil  same  as  for  mutton  chops,  except  that 
they  are  to  be  well  done  instead  of  rare,  to  accomplish  this 
about  three  minutes  longer  cooking  will  be  required;  for  a 
chop  one  inch  thick,  from  eight  to  ten  minutes. 

TRENCH  CHOPS  1 

Trim  a  chop  until  there  is  nothing  left  but  the  round 
muscle  at  the  thick  end,  with  a  little  fat  about  it.  Cut  away 
all  the  meat  from  the  bone,  which  will  then  look  like  a  handle 
with  a  meat  morsel  at  one  end.  Broil,  and  serve  on  hot 
platter  with  paper  handles  on  chops,  and  garnished  with  pars- 
ley and  peas. 

PAN-BROILED  CHOPS  i 

Chops  are  fairly  good  pan-broiled.  The  same  principle  is 
to  be  followed  as  in  the  cooking  over  coals  —  that  is,  a  high 
degree  of  heat  at  first,  to  sear  the  outside  before  the  juice 

1  Chops  average  300  Cal.  per  100  gms. 


MEAT 


151 


escapes^  and  a  lower  temperature  afterward  —  therefore,  heat 
the  saute  pan  or  spider  exceedingly  hot  (use  no  fat),  drop  in 
the  chop,  count  ten  and  turn,  repeating  for  about  one  minute,, 
then  draw  the  pan  to  the  back  or  side  of  the  stove  and  finish 
cooking  slowly.  A  chop  one  inch  thick  will  be  perfectly  done 
in  from  five  to  seven  minutes.  If  the  pan  is  hot  enough  at 
first  there  will  be  no  loss  of  juice  or  flavor.  Season  and  serve 
in  the  same  manner  as  broiled  chops. 

CHOPS  (OR  BIRDS)  BROILED  IN  PAPER  i 

Prepare  a  chop  as  for  pan-broiling.  Spread  a  piece  of 
paper  evenly  and  thickly  with  butter.  Lay  on  it  a  nicely 
trimmed  chop  and  double  the  paper  with  edges  together* 
Fold  and  crease  the  edges  on  the  three  sides,  then  fold  and 
crease  again,  so  that  the  butter  cannot  run  out.  These  folds 
should  be  half-an-inch  wide.  It  will  be  necessary  to  have 
the  sheet  of  paper  —  foolscap  or  heavy  white  paper  —  consid- 
erably more  than  twice  as  large  as  the  chop.  Broil  over  coals, 
not  too  near,  turning  often  so  that  the  temperature  will  not 
get  so  high  as  to  ignite  the  paper.  A  chop  broiled  in  this  way 
is  basted  in  the  butter  and  in  its  own  juices,  and  is  very  deli- 
cate. A  chop  three-quarters  of  an  inch  thick  will  cook  in  five 
minutes ;  one  an  inch  thick,  in  eight. 

Should  the  paper  ignite,  it  need  not  destroy  the  chop. 
Take  it  out  and  put  into  a  fresh  paper  and  try  again.  The 
chop  should  be  served  hot,  seasoned  with  salt  and  pepper. 

Note. —  Birds  may  be  broiled  in  the  same  way. 

BROILED  BACON 

Cut  bacon  in  as  thin  slices  as  possible,  and  remove  rind. 
Put  in  broiler,  placing  broiler  over  baking  pan,  and  cook  in 
hot  oven  until  crisp. 

CURLED  BACON 

Heat  saute  pan  very  hot.  Put  in  strips  of  very  thin  sliced 
bacon.  As  fat  is  drawn  out,  pour  it  off  into  cup ;  cook  bacon 
until  crisp  and  brown.    Drain  on  brown  paper. 

^  Chops  average  300  Cal.  per  100  gms. 


152 


ANIMAL  FOODS 


BROILED  HAM 

Cut  slices  of  ham  one-third  inch  thick.  If  very  salt  soak 
fifteen  minutes  in  lukewarm  water ;  broil  three  minutes  or  un- 
til brown  on  both  sides^  turning  frequently.  A  slice  of  boiled 
ham.  is  very  delicate  cooked  in  this  same  way,  cooking  it  less 
time. 

ROAST  MEATS 

Prepare  meat,  put  on  rack  in  dripping  pan,  dredge  with 
salt  and  flour  and  cook  in  hot  oven  until  the  surface  is  seared, 
reduce  the  heat  and  cook  slowly  the  required  time. 

Beef,  rare    13  minutes  per  pound. 

Beef,  rare  (over  5  lbs.)   18  minutes  per  pound. 

GRAVY  rOR  ROAST  MEATS 

1  tablespoon  fat.  1  cup  boiling  water. 

1  tablespoon  flour. 

Pour  fat  from  baking  pan  and  return  to  pan  the  quantity 
desired.  Add  flour  and  when  well  browned  pour  on  gradually 
the  boiling  water,  stirring  constantly.  Cook  five  minutes, 
season  with  salt  and  pepper,  and  strain. 

POULTRY  AND  GAME^ 

Poultry  and  game  are  generally  classed  together,  poultry 
being  applied  to  domesticated  birds  raised  for  their  flesh  or 
eggs  or  both.    Wild  birds  are  all  classed  as  game. 

Digestibility.  Chicken  may  be  introduced  early  into  the 
dietary  of  the  convalescent,  for  it  is  one  of  the  most  easily 
digested  of  meats.  Chicken  is  more  easily  digested  than 
fowl,  but  is  not  as  nutritious.  The  white  meat  of  the  breast 
is  particularly  free  from  fat,  has  short  fibers  and  small  amount 
of  connective  tissues,  and  is  easier  to  digest  than  the  dark 
meat. 

Squab,  quail,  pigeons  and  the  white  meat  of  turkey  are  also 
easily  digested. 

Duck  and  goose  contain  a  large  quantity  of  fat  and  are  not 
as  easily  digested. 

1  For  further  information,  note  "Poultry  as  Food."  Farmer's  Bulletin, 
No.  182,  Dept.  of  Agriculture,  W^^shington-  X).  C. 


POULTRY  AND  GAME 


153 


Game  is  comparatively  easy  of  digestion  bnt  too  highly 
flavored  for  most  invalids.  The  cuts  from  the  breast  are 
the  best  for  an  invalid. 

Test  for  Selecting  a  ChicJcen.  The  cartilage  at  the  end  of 
the  breast  bone  must  be  soft  and  pliable,  the  skin  smooth 
and  the  feet  soft.  There  should  be  an  abundance  of  pin 
feathers.    Chickens  are  used  for  broiling  and  roasting. 

Test  for  Selecting  a  Fowl.  The  cartilage  at  end  of  the 
breast  bone  is  firm,  the  feet  are  hard  and  dry.  The  pin  feath- 
ers are  largely  replaced  with  long  hair.  An  old  fowl,  not  too 
fat,  is  best  for  broths.  One  from  one  to  two  years  is  best  for 
roasting,  or  where  the  meat  substance  is  desired.  The  propor- 
tion of  bone  to  meat  in  chicken  under  this  age  makes  them 
expensive  eating. 

Principles  of  CooJcing.  In  general  same  as  for  cooking  of 
other  meats. 

When  the  layer  of  meat  over  the  bones  is  very  thin,  as  in 
young  chickens  or  squabs,  broiling  is  preferable  to  roasting. 

An  old  fowl  can  sometimes  be  made  tender  without  having 
all  its  flavor  stewed  into  the  broth,  by  cooking  in  a  small 
amount  af  water  in  a  double  boiler  for  a  long  time,  or  in  a 
fireless  cooker. 

A  general  rule  for  roasting  chickens  or  turkeys  is  twenty 
minutes  to  the  pound.  Ducks  and  geese,  having  tougher 
fibers,  require  a  longer  time  for  thorough  cooking. 

GENERAL  RULE  FOR  CLEANING  POULTRY 

Cut  off  head  and  feet  and  pull  out  pin  feathers.  If  the 
bird  has  not  been  drawn,  make  an  incision  below  the  breast 
just  large  enough  to  admit  the  hand  (or  finger  for  the  small 
birds).  With  the  hand  or  finger,  draw  all  the  entrails  out  at 
one  time.  Care  must  be  taken  not  to  break  them,  especially 
the  gall-bladder.  Turn  down  the  skin  of  the  neck,  cut  off 
neck  close  to  body  and  pull  out  wind  pipe  and  crop.  Cut 
out  the  oil  bag.  Cut  through  skin  of  the  leg  a  little  below  the 
joint  (not  cutting  the  tendons),  press  against  table  and  break 
and  pull  off  foot  with  tendons,  which  will  come  out  in  break- 


154 


ANIMAL  FOODS 


ing  if  chicken  is  young.  In  fowls  you  may  have  to  pull  them 
out  separately  with  skewer.  Singe  the  bird  by  holding  it 
over  a  tablespoon  of  burning  alcohol,  or  paper  (holding  over 
sink).  Wash  by  allowing  the  cold  water  to  run  through  and 
over  it,  and  dry  well  inside  and  out  and  prepare  further  for 
broiling  or  roasting,  etc. 

DRY  DRESSING  FOR  STUFFING,  1100  CALORIES 

1%  cup  stale  bread  crumbs.  Powdered  sage,  marjoram,  and 
1/3  cup  butter  (not  melted).  .  summer  savory. 

Salt,  pepper. 

Thoroughly  mix  ingredients  and  season  to  taste.  Fill  in 
both  openings  of  bird  and  sew  the  skin  at  both  ends,  and  turn 
the  skin  of  neck  over,  and  fasten  to  back.  Oysters  can  be 
added  to  dressing  if  desired,  omitting  all  seasonings  but  the 
salt  and  pepper. 

TO  TRUSS  POULTRY 

After  stuffing  and  sewing  up  the  openings,  draws  the  thighs 
close  to  body  and  secure  in  place  by  putting  a  skewer  through 
them  and  the  body.  Fold  wings  under  back  by  taking  end 
of  wing  and  place  in  under  back  which  fastens  it.  Cross  the 
drum-sticks  and  tie  with  long  string  and  fasten  to  the  tail, 
and  tie  string  so  that  it  will  hold  thighs  close  to  the  body. 
Cut  and  remove  string  before  serving  the  bird. 

ROAST  POULTRY 

100  grams     about  200  Calories.^ 

Clean,  stuff  and  truss  bird  and  place  it  on  its  back  on 
rack  in  dripping  pan.  Eub  surface  with  salt  and  a  butter  and 
flour  mixture  (mix  three  tablespoons  of  butter  and  two  table- 
spoons of  flour  and  stir  until  creamy).  Dredge  bottom  of 
pan  with  flour.  Place  in  hot  oven  and  in  about  ten  minutes 
the  flour  should  be  well  browned,  then  reduce  heat  of  oven  and 
cook  more  slowly.  Baste  every  ten  minutes  with  one-fourth 
cup  of  butter  melted  in  three-fourths  cup  of  water,  after  this 

1  Edible  portion. 


POULTRY  AND  GAME 


155 


has  been  exhausted  use  fat  in  pan.  Turn  bird  often  while 
cooking  that  it  may  brown  evenly.  When  cooked,  remove  to 
hot  platter  and  make  the  gravy. 

A  chicken  four  to  five  pounds  will  require  about  one  and 
one-half  to  two  hours  for  cooking.  Turkey,  nine  pounds,  two 
and  one-half  to  three  hours.  Ducks  (domestic),  one  to  one 
and  one-half  hours.  Duck  (wild),  twenty-five  to  thirty  min- 
utes.   Goose,  nine  pounds,  two  to  two  hours  and  one-half. 

GRAVY  FOR  ROAST  POULTRY 

Clean  the  heart,  liver  and  gizzard  by  removing  the  mem- 
brane, blood  vessels  and  clotted  blood  from  the  heart.  Cut 
liver  from  the  gall  bladder  and  remove  all  green  on  liver. 
Clean  gizzard  and  cut  through  edge  carefully  to  sac,  and  re- 
move carefully  not  to  break  it,  wash  giblets  (that  is,  the 
heart,  liver,  gizzard)  and  the  neck  and  put  on  to  cook  in  two 
and  one-half  cups  of  cold  water,  cook  slowly  at  the  simmering 
point  until  tender. 

After  chicken  has  been  removed  from  pan,  pour  off  all  the 
fat,  strain  and  return  to  pan  four  tablespoons  of  fat  and  add 
four  tablespoons  of  flour,  brown  together  thoroughly,  and  add 
gradually-  the  water  the  giblets  were  cooked  in.  Cook  five 
minutes,  stirring  constantly,  add  hot  water  if  gravy  is  too 
thick,  and  salt  and  pepper  to  taste,  and  the  finely-chopped 
giblets. 

TO  BONE  BIRDS 

Select  bird  that  is  fresh-killed,  dry-picked,  and  not  drawn. 
Cut  off  head  and  feet,  singe  and  remove  pin  feathers,  crop,  and 
oil  bag.  Cut  off  wings  close  to  body.  Lay  on  board  breast 
down  and  cut  to  bone  the  entire  length  of  spine.  Scrape  the 
flesh  from  backbone  the  entire  length  of  body,  working  toward 
the  breast,  cutting  the  tendinous  portions  as  reached.  When 
edge  of  breastbone  is  reached,  care  must  be  taken  not  to  break 
through  skin.  Scrape  flesh  from  second  joint  and  drum- 
sticks, laying  flesh  back  and  pulling  out  bone  (as  if  turning 
glove  off  inside  out). 

Scrape  flesh  from  lower  part  of  back  and  withdraw  from 


156 


ANIMAL  FOODS 


carcass.  Put  flesh  in  original  shape  and  broil,  following 
directions  for  broiled  quail;  or  stuff  bird  with  stale  bread 
crumbs  and  tie  in  shape  with  string  and  bake  in  hot  oven. 
When  cooked,  remove  bread  and  tie  in  shape  with  a  bit  of 
white  baby  ribbon  and  garnish  with  parsley  and  lemon. 

BROILED  QTTAIL 

100  grams  =  160  Calories. 
Clean^  cut  off  the  head  and  feet,  singe,  and  wipe  with  a 
damp  cloth.  With  a  sharp-pointed  knife  split  the  quail  down 
the  back,  beginning  at  back  of  neck  and  cutting  through  the 
backbone  the  entire  length  of  bird.  Lay  bird  open  and  re- 
move contents.  Cut  through  tendons  at  joints.  Wipe  thor- 
oughly. Season  with  salt  and  pepper,  rub  thickly  with  soft- 
ened butter  and  dredge  with  flour.  Broil  ten  minutes  over 
clear  coals.  Serve  on  hot  buttered  toast.  Garnish  with  toast 
points,  parsley  and  currant  jelly. 

BROILED  SaiTABS 

100  grams  =  390  Calories. 

Prepare,  cook  and  serve  the  same  as  quail. 

BROILED  SMALL  BIRDS 

All  small  birds  can  be  broiled  according  to  the  directions 
for  quail,  remembering  that  for  very  small  ones  it  takes  a  very 
bright  fire,  as  the  birds  should  only  be  browned  and  the  time 
required  for  cooking  is  brief. 

BIRDS  BROILED  IN  PAPER 

See  chapter  on  Meats  and  follow  directions  for  Chops 
Broiled  in  Paper.''    Page  151. 

BROILED  CHICKEN 

100  grams      108  Calories.i 

Dress  for  broiling,  following  directions  given  under  Broiled 
Quail.  Season  well  with  salt  and  pepper,  and  rub  all  over 
with  softened  butter,  especially  breast  and  legs.  Put  in  a 
well-greased  broiler  and  broil  over  a  clear  fire  about  fifteen 

1  Edible  portion. 


POULTRY  AND  GAME 


157 


minuteS;,  turning  often.  The  flesh  side  must  be  exposed  to 
the  fire  the  greater  part  of  the  time  as  the  skin  side  burns 
easily.  When  chicken  is  nicely  browned,  place  in  a  dripping- 
pan,  skin  side  down,  in  a  moderate  oven  twelve  minutes.  Put 
on  a  hot  dish,  season  with  salt,  pepper  and  butter,  and  serve 
immediately. 

This  rule  is  for  a  chicken  weighing  about  two  and  a  half 
pounds,  yielding  725  calories. 

CREAMED  CHICKEN,  210  CALORIES  i 

(Individual  Rule.) 
1/3  cup  cold  cooked  chicken.  %  tablespoon  butter. 

Speck  celery  salt.  l^  tablespoon  flour. 

Salt.  %  cup  rich  milk. 

Pepper. 

Melt  butter  in  saucepan,  add  flour  and  pour  on  gradually 
the  scalded  milk.  Cook  thoroughly.  Add  chicken  cut  into 
dice,  and  seasonings.  Heat  well  and  serve  on  toast  rounds, 
garnished  with  toast  points  and  parsley;  or  use  as  a  filling 
for  Swedish  timbales. 

Note. —  Chicken  may  be  used  that  is  removed  from  chicken 
hroth  when  it  is  tender.  Chicken  broth  may  replace  part  of 
the  milk  in  making  the  sauce. 

SCALLOPED  CHICKEN 

Put  creamed  chicken  into  a  small  baking  dish,  cover  with 
dried  bread  or  cracker  crumbs,  dot  with  small  pieces  of  but- 
ter, and  brown  in  oven. 

JELLIED  CHICKEN,  100  CALORIES  2 

(Individual  Rule.) 

1  teaspoon  gelatin.  14  cup  chopped  chicken. 

2  tablespoons  cold  water.  Salt,  celery  salt. 
8    tablespoons    strong  chicken 

broth. 

Soak  gelatin  in  the  cold  water  five  minutes,  and  add  the 
boiling  hot  broth,  stir  until  dissolved.    Season  to  taste.  Dip 

^  Calculated  with  1      ounce  of  fowl. 
2  About  100  calories. 


168 


ANIMAL  FOODS 


mold  into  cold  water  and  pour  in  enough  gelatin  to  cover 
bottom,  put  in  ice  box  to  harden,  when  firm  decorate  with  a 
slice  of  hard-cooked  egg;  or  cook  a  couple  slices  of  carrots 
and  cut  a  small  round  from  one  slice  to  form  the  center  of 
a  daisy  and  cut  the  other  slice  into  strips  to  represent  the 
petals  and  put  in  bottom  of  mold,  add  a  few  drops  of 
gelatin  to  keep  the  decoration  in  place,  and  put  on  ice  to 
harden.  Mix  the  chicken  with  remainder  of  gelatin  and  pour 
into  mold  and  set  to  harden.  Serve  on  leaf  of  lettuce  or 
garnish  with  parsley. 

LAEDED  6E0TJSE 

Clean  and  wash  the  grouse.  Lard  the  breast  and  legs. 
Eun  a  small  skewer  through  the  legs  and  tail.  Tie  firmly 
with  twine.  Dredge  with  salt,  rub  the  breast  with  softened 
butter,  then  dredge  with  flour.  Put  into  a  quick  oven.  If 
desired  rare,  cook  twenty  minutes;  if  well  done,  thirty  min- 
utes. Serve  on  hot  platter  garnished  with  parsley  and  Bread 
Sauce. 

LARDED  QTTAIL 

100  grams  =  160  Calories. 

The  directions  for  cooking  and  serving  are  the  same  as  for 
grouse,  except  that  quail  cook  in  fifteen  minutes.  Larding 
gives  richness  to  dry  meat  that  does  not  have  fat  enough  of 
its  own. 

BREAD  SAUCE  EOR  GAME,  540  CALORIES 

Crumbs 

%  cup  coarse  dried  bread  crumbs.  %  small  onion. 

14  tablespoon  butter.  1  tablespoon  butter. 

Sauce 

1  cup  milk.  Salt. 
14  cup  fine  bread  crumbs.  Pepper. 

Prepare  Crumbs.  Dry  in  a  warm  oven;  sift.  Cook  the 
coarse  bread  crumbs  in  the  butter  until  a  delicate  brown,  and 
use  to  cover  breast  of  bird. 

Prepare  Sauce.    Put  the  fine  bread  crumbs,  milk  and 


FISH 


159 


onion  on  to  scald  ten  minutes^  then  skim  out  the  onion,  add 
the  butter  and  seasoning,  and  serve  as  a  gravy  for  birds. 

FISH 

Fish  is  one  of  the  important  protein  foods.  The  term  is 
usually  applied  to  all  kinds  of  water  animals  used  for  food. 
They  may  be  classified  as  follows : 

Halibut 
Haddock 
Flounder 
Turbot 
White  Fish 
Smelt 
Cod 


Classes 


1.  Scaly  or  Vertebrate. 


White  or  lean,  e.  g. 


.2.  Shell-fish 


Dark  or  oily,  e.  g. 


Mollusks,  e.  g. 


Crustaceans,  e.  g. 


'Salmon 
Mackerel 
Blue  Fish 
Shad 
Herring 
Eel 

J  Oysters 
I^Clams 

Crabs 
Lobsters 
Shrimps 
Turtles 
^Terrapin 


In  the  white-fleshed  fish  the  fat  is  found  principally  in 
the  liver.  This  is  the  only  class  usually  considered  in  the 
cookery  for  the  sick. 

In  the  dark-fleshed  fish  the  fat  is  found  distributed  through- 
out the  body.  A  considerable  amount  of  the  protein  of  fish 
is  in  the  form  of  gelatin.  Fish  is  less  rich  in  extractives,  and 
hence  less  stimulating  than  meat. 

Digestibility,  The  digestibility  of  scaly  fish  depends  upon 
the  quantity  of  fat  present  and  the  coarseness  of  the  fiber. 


160 


ANIMAL  FOODS 


The  white-fleshed  fish  are  less  nutritious  and  stimulating  than 
the  dark-fleshed  fish  as  they  contain  less  fat  and  extractives 
and  more  water.  They  are  consequently  more  easily  digested. 
With  the  exception  of  cod,  white  fish  is  useful  for  a  con- 
valescent diet,  for  those  of  sedentary  habits,  for  children,  and 
others  for  whom  the  stimulating  extractives  of  meat  are  not 
desirable. 

Oily  fish  should  not  be  eaten  by  those  of  weak  digestion 
or  given  to  the  sick.  In  some  cases  they  may  be  served  dur- 
ing advanced  convalescence. 

Salt  fish  is  not  as  easily  digested  as  fresh  fish^  as  the  fibers 
are  apt  to  be  hardened  in  the. process  of  salting.  Salt  codfish 
is  an  exception,  for  if  finely  divided  and  served  in  an  ap- 
petizing manner  it  is  a  valuable  and  inexpensive  form  of 
protein  food.  As  a  rule,  dried,  smoked  or  pickled  fish  should 
not  be  given  to  the  sick. 

By  some  persons,  fish  cannot  be  eaten  without  causing  in- 
digestion or  biliousness.  A  complete  diet  of  fish  is  said  to 
cause  an  affection  of  the  skin.  The  fat  sometimes  disagrees, 
causing  acidity  and  eructations  of  the  stomach. 

Composition.  In  composition  fish  is  similar  to  meat,  con- 
taining proteins,  extractives,  fats,  salts  and  water.  As  a  rule, 
fish  contains  more  water  and  less  fat  than  meat,  therefore  it 
is  more  easily  digested ;  and  it  is  due  to  this,  its  easy  digesti- 
bility, that  white  fish  by  some  is  considered  a  brain  food,  and 
not,  as  is  popularly  supposed,  to  the  amount  of  phosphorus  it 
contains;  in  fact,  fish  does  not  contain  as  much  phosphorus 
as  some  meat.  Pish  contains  less  extractives  than  meat  and 
it  is  due  to  this  that  people  tire  more  quickly  of  it  than  of 
meat. 

Lemon  juice  and  vinegar  are  desirable  condiments  to  serve 
with  fish.  The  acid  is  a  desirable  neutralizing  agency,  as  the 
juice  of  fish,  especially  shellfish,  is  of  an  alkaline  nature. 

Nutritive  Value,  The  chief  nutritive  constituents  of  fish, 
as  of  meat,  are  their  proteins  and  fats.  Their  energy  value 
depends  larsjely  on  the  amount  of  fat  they  contain. 


FISH 


161 


When  Fish  are  in  Season,  Halibut,  haddock,  flounder  and 
cod,  are  in  season  all  the  year. 

Turbot,  October  to  May;  shad,  February  to  May;  salmon. 
May  to  September;  blue  fish  and  mackerel.  May  to  October; 
sturgeon,  April  to  September;  trout  (lake),  April  to  August. 

Test  for  Freshness.  In  fresh  fish  the  gills  are  red,  the  eyes 
bright  and  protruding,  the  flesh  is  firm  and  there  is  no  un- 
pleasant odor.  The  first  two  tests  disappear  after  the  fish 
has  been  out  of  water  a  short  time,  and  although  the  flavor  of 
the  fish  is  not  as  good,  it  is  not  spoiled.  But  if  the  last  two 
tests  are  not  present  the  fish  should  not  be  used.  Great  care 
should  be  taken  that  fish  is  perfectly  fresh,  in  season,  and 
thoroughly  cooked,  or  it  will  be  indigestible  and  sometimes 
poisonous.  Unless  these  conditions  are  known  to  exist,  fish 
should  not  be  served  to  the  sick. 

"  In  many  European  cities  fish  are  sold  alive,  the  customer 
selecting  his  fish  as  it  swims  in  a  tank.  It  would  seem  that 
this  excellent  method  might  be  used  in  our  cities,  especially 
those  situated  on  the  seaboard,  at  least  for  customers  who  are 
fastidious  and  who  are  willing  to  pay  an  extra  price  for 
a  special  article  when  it  is  warranted.^^  (Farmer's  Bulletin 
No.  375.) 

Principles  to  he  Observed  in  CooTcing  Fish,  As  in  meat, 
albumin  is  the  principal  constituent  to  be  considered  in  the 
cooking  of  fish.  Hence  the  same  principles  which  apply  to 
the  cooking  of  meat  apply  also  to  the  cooking  of  fish. 

See  page  11,  for  effect  of  heat  on  albumin. 

Objective  Points  and  Methods: 

To  Ketain  the  Juice. —  Baking,  Broiling,  Boiling  and  Fry- 
ing. 

To  Extract  the  Juice. —  Soup. 

To  Extract  and  Eetain  the  Juice. —  Chowder. 

ENERGY  VALUE  OF  FISH 

See  Table,  under  names  of  fish,  as  Halibut,  Salmon,  ^tc. 
See  Table,  page  64,  for  energy  value  of  other  ingredients. 


162 


ANIMAL  FOODS 


BEOILED  FISH 

White  fish,  trout,  small  blue  fish,  mackerel,  shad  and  small 
eod  should  be  split  down  the  back,  and  broiled  whole,  and  if 
preferred,  cut  off  the  head  and  tail.  Halibut  and  salmon 
should  be  cut  into  inch  slices  and  turned  often  while  broil- 
ing. 

Clean  Fish.  Wipe  with  a  cloth  wet  in  salt-water,  and  dry- 
on  a  fish  towel.  Season ;  oily  fish  need  only  salt  and  pepper, 
but  dry  white  fish  should  be  spread  with  butter  and  salt  and 
pepper  before  broiling.  Use  a  double  wire  broiler  greased 
well  with  salt  pork  rind.  Put  thickest  edge  of  fish  next 
middle  of  broiler,  turn  often  while  broiling;  with  split  fish 
sear  the  fiesh  side  first  and  then  turn. 

The  time  of  cooking  will  vary  with  the  thickness  of  fish. 
Fish  is  done  when  fiesh  separates  easily  from  the  bone. 

The  fire  should  be  hot  and  clear.  When  ready  to  serve, 
loosen  the  fish  from  broiler  on  each  side.  Open  broiler,  slide 
fish  onto  platter,  having  flesh  side  uppermost.  Spread  with 
butter,  salt  and  pepper.  Garnish  with  parsley  and  slices  of 
lemon.  Or  serve  with  Butter  Cream  and  a  border  of  potato 
balls. 

Note  "  Fish  Sauces    for  Butter  Cream. 

BAKED  FISH 

Clean  fish.  Wipe  with  cloth  wet  in  salted  water,  dry  on  a 
fish  towel  and  bake  on  a  greased  fish  sheet,  placed  in  a  drip- 
ping pan.  A  strip  of  cotton  cloth,  by  which  it  may  be  lifted 
from  the  pan,  may  be  substituted  for  the  fish  sheet.  Sprinkle 
with  salt  and  pepper,  brush  over  with  melted  butter,  dredge 
with  fiour,  and  place  around  fish  small  pieces  of  fat  salt  pork. 
Bake  in  hot  oven  until  fish  separates  from  bone  when  lifted 
with  fork.  Baste  every  ten  minutes.  Serve  plain  with 
melted  butter,  or  with  Egg  Sauce. 

Note  "  Fish  Sauces    for  Egg  Sauce. 


FISH 


163 


HALIBUT  A  LA  CREOLE,  413  CALORIES 

^4  pound  halibut.  1  clove. 

%  cup  tomatoes.  %  teaspoon  sugar. 

%  cup  water.  %  tablespoon  butter. 

Small  piece  onion.  %  tablespoon  flour. 

Sprig  parsley.  Salt  and  pepper. 

Tomato  Sauce.  Blend  tomatoes^  water^  onion,  parsley, 
clove  and  sugar,  and  cook  ten  minutes. 

Melt  the  butter,  add  the  flour  and  pour  on  gradually  the 
hot  mixture.  Add  salt  and  pepper  to  taste,  cook  five  minutes 
and  strain. 

Clean  fish.  Wipe  with  cloth  wet  with  cold  salted  water 
and  dry  thoroughly.  Put  in  baking  tin,  pour  around  half 
the  sauce  and  bake  until  fish  separates  easily  from  bone, 
basting  often.  Serve  on  hot  platter,  pour  around  it  the  re- 
mainder of  the  sauce  and  garnish  with  parsley. 

CREAMED  FISH 

(Individual  Rule.) 
14  cup  cooked  fish,  remove  skin  %   cup   cream  or   white  sauce 
and  bone,  and  flake  the  flesh       (note  Fish  Sauces), 
with  a  fork;  season  with  salt, 
pepper,    and    a    little  lemon 
juice. 

Blend  the  fish  and  white  sauce,  reheat  and  serve  on  toast, 
garnish  with  parsley  and  half-slice  of  lemon;  or  serve  in 
bread  cases  made  of  slices  of  bread  cut  two  inches  thick, 
round  off  edges,  scoop  out  center,  leaving  case,  brush  with 
softened  butter  and  brown  in  oven. 

Jfote. —  White  sauce  may  be  poured  on  one  egg  yolk  before 
adding  fish. 

SCALLOPED  FISH 

Put  creamed  fish  into  small  baking  dish,  cover  with  dried 
bread  or  cracker  crumbs;  dot  with  bits  of  butter  and  brown 
in  oven. 

CREAMED  CODFISH,  828  CALORIES 

Flake  salt  codfish  in  small  pieces,  remove  the  bone ;  the  fish 
should  be  put  into  several  cold  waters  to  remove  some  of  the 


164 


ANIMAL  FOODS 


salt.  Prepare  the  potatoes,  cutting  them  into  eighths,  or  if 
small  into  fourths,  add  the  shredded  fish  and  boiling  water 
to  cover;  cook  until  potatoes  are  tender,  drain  off  the  water 
(saving  it  for  the  sauce),  add  a  little  butter  and  season  with 
pepper,  and  mash  lightly  and  heap  in  center  of  platter. 

Sance 

1  pint  fish  and  potato  water.        4  tablespoons  flour. 
4  tablespoons  butter.  Pepper. 

Melt  the  butter,  add  the  flour  and  pour  on  gradually  the 
potato  water.  Cook  thoroughly,  season  with  pepper,  and 
pour  about  the  codfish,  and  garnish  with  slices  of  hard-cooked 
egg  and  parsley. 

CREAMED  CODFISH  (FOR  THE  DIABETIC),  314  CALORIES 

%  cup  flaked  codfish.  %  teaspoon  Gum  Gluten  fiour. 

1  cup  milk  or  cream.  Yolk  1  egg. 

l^  teaspoon  butter.  Pepper. 

Soak  the  fish  in  two  waters ;  melt  the  butter,  add  the  flour 
and  pour  on  gradually  the  scalded  milk ;  cook  thoroughly^  add 
codfish  and  egg,  cook  five  minutes,  season  and  serve  on  Gum 
Gluten  toast  or  fresh  bread. 

CREAMED  FISH  (FOR  THE  DIABETIC),  208  CALORIES 

%  cup  cooked  fish.  %  cup  cream  sauce. 

Salt,  pepper,  lemon  juice.  Gum  Gluten  bread  crumbs. 

Season  fish  with  salt,  pepper  and  lemon  juice,  add  cream 
sauce,  put  into  ramikins  or  cups,  sprinkle  with  Gum  Gluten 
crumbs,  and  bake. 

BAKED  FISH  (FOR  THE  DIABETIC),  480  CALORIES 

For  baked  fish  make  a  dressing  with  one  cup  of  Gum 
Gluten  bread  crumbs,  one-half  an  onion,  chopped  fine;  one 
tablespoon  celery,  chopped  fine,  one  tablespoon  of  butter ;  pep- 
per, salt,  lemon  juice  and  parsley. 

FISH  (FOR  THE  DIABETIC) 

Fish  should  be  rubbed  with  salt  and  pepper  and  dipped  in 
Gum  Gluten  Flour,  or  rolled  in  egg  and  Gum  Gluten  Cracker 
crumbs.    Saute  (or  fry)  in  oil  or  butter. 


FISH  SAUCES 


165 


FISH  SAUCES 

BTJTTER  CREAM 

Cream  a  little  butter;  season  with  salt^  cayenne,  lemon 
juice  (speck  salt  and  pepper,  one-half  teaspoon  lemon  juice). 
Add  finely  minced  parsley  or  chopped  pickle,  such  as  cucum- 
ber or  olive.  Prepare  quantity  according  to  size  of  fish.  Put 
it  on  the  fish,  and  place  in  oven  a  moment  until  butter  is 
melted. 

CREAM  OR  WHITE  SAUCE,  125  CALORIES 

(Individual  Rule.) 
%  tablespoon  butter.  cup  hot  milk. 

l^  tablespoon  flour.  Salt. 

Melt  butter,  add  flour,  remove  from  fire,  and  pour  on 
gradually  the  milk,  stirring  constantly.  Bring  to  the  boiling 
point,  cook  thoroughly  and  season. 

Note. —  Extra  milk  may  be  added  if  a  thinner  sauce  is 
desired,  using  one-half  cup  milk. 

CREAM  SATJCE  (FOR  THE  DIABETIC),  138  CALORIES 

l^  cup  milk.  Salt. 

1  teaspoon  Gum  Gluten  flour.  Cayenne. 

1  teaspoon  butter. 

Melt  the  butter,  add  the  flour  and  pour  on  gradually  the 
scalded  milk ;  cook  thoroughly  and  season. 

EGG  SAUCE,  434  CALORIES 

tablespoons  butter.  Speck  pepper. 

ll^  tablespoons  flour.  %  cup  hot  water. 

14  teaspoon  salt.  2  eggs. 

Melt  one-half  the  butter;  add  flour  and  seasoning  and 
pour  on  gradually  the  hot  water.  Boil  five  minutes  and  add 
remainder  of  butter  in  small  pieces.  Add  two  hard-cooked 
.eggs  cut  into  one-fourth  inch  slices,  or  the  beaten  yolks  may 
be  added  to  hot  sauce  with  one-half  teaspoon  lemon  juice. 


166 


ANIMAL  FOODS 


EGG  SAUCE  NO.  II 

To  Cream  or  White  Sauce  add  one  hard-cooked  egg  chopped 
fine  and  a  little  lemon  juice  if  desired;  or  add  to  White 
Sauce^  yolk  slightly  beaten  and  a  few  drops  of  lemon  juice. 

TOMATO  SAUCE,  80  CALORIES 

%  tablespoon  butter.  Few  grains  salt. 

l^  tablespoon  flour.  Few  grains  pepper. 

14  cup  strained  tomato  juice. 

Brown  butter^  add  flour  and  stir  until  slightly  browned; 
remove  from  fire  and  pour  on  gradually^,  stirring  constantly, 
the  heated  tomato.    Cook  thoroughly  and  add  salt  and  pepper. 

Note. —  A  sprig  of  parsley,  one  clove  and  a  small  piece  of 
onion  may  be  added  to  tomato  while  heating. 

CUCUMBER  RELISH,  15  CALORIES 

Grate  one-half  cucumber  and  add  a  small  piece  of  red  pep- 
per chopped  fine;  season  with  salt,  pepper  and  vinegar  and 
serve  with  fish. 

HOLLANDAISE,  484  CALORIES 

1  egg  yolk.  Vs  teaspoon  salt. 

4  tablespoons  butter.  White  pepper. 

%  tablespoon  vinegar.  3  tablespoons  boiling  water. 

Put  one  tablespoon  butter  in  top  of  double  boiler,  add  the 
other  ingredients.  Place  over  hot  water  and  stir  constantly 
while  butter  is  melting.  Add  second  tablespoon  of  butter 
and  stir  until  melted,  repeat  this  process  until  all  butter  is 
used.  As  soon  as  the  mixture  begins  to  thicken  remove  from 
hot  water.  Vary  by  adding  a  little  chopped  parsley,  grated 
horse-radish  root. 

SHELL-FISH 

OYSTERS  AND  CLAMS 

Only  the  mollusks  are  considered  in  this  book,  because  the 
crustaceans  are  not  easily  digested,  and  therefore  are  not  suit- 
able for  an  invalid  diet. 

Oysters.    Oysters  are  valuable  food  for  invalids  and  con- 


SHELL-FISH 


valescents.  Their  nutritive  value  is  not  high,  but  they  are 
easily  digested  and  possess  a  delicate  flavor  which  is  ac- 
ceptable to  most  palates. 

Composition.  The  five  food  principles  are  represented  in 
oysters.  Eeckoned  as  "  solid/^  i.  e.,  removed  from  the  shell, 
oysters  contain  88.3  per  cent,  of  water,  6.1  per  cent,  protein, 
1.4  per  cent,  fat,  and  3.3  per  cent,  carbohydrate.  Oysters 
come  nearer  to  milk  than  almost  any  other  common  food 
material,  both  in  amount  and  proportion  of  nutritive  prin- 
ciples. 

The  carbohydrate  is  in  the  form  of  glycogen,  being  found 
in  the  liver,  which  constitutes  a  large  proportion  of  the  oyster. 

Digestibility,  The  soft  part  of  the  oyster  or  clam  is  made 
up  largely  of  the  stomach  and  liver  and  is  easily  digested 
when  cooked  in  a  variety  of  ways  —  broiling,  roasting,  stew- 
ing, panning  and  steaming  —  but  not  fried  when  served  to 
the  sick. 

The  hard  part  of  shellfish  is  the  muscle  which  fastens  the 
animal  to  the  shell,  and  is  rendered  tougher  by  all  forms  of 
cooking;  therefore,  when  whole  oysters  are  to  be  eaten,  they 
are  more  easily  digested  when  served  raw  or  broiled  slightly 
in  the  shell.  They  can  be  digested  by  fever  patients  and 
those  suffering  from  many  forms  of  gastric  disorders. 

It  is  desirable  in  acute  illness  to  serve  only  the  soft  part 
of  the  oyster,  but  in  the  later  stages  of  convalescence  the 
whole  oyster  can  be  served  raw  or  in  stew  and  soups,  which 
are  recommended  on  account  of  their  liquid  form  and  warmth. 

When  in  Season.  Oysters  are  in  season  from  September  to 
May.  During  the  rest  of  the  year  they  are  insipid  and  unfit 
for  food. 

Principles  to  be  Carefully  Observed  in  Serving  and  Cook- 
ing Oysters  for  the  Sick,  (a)  Make  every  effort  to  have  the 
oyster  alive  when  used,  or  as  fresh  as  can  be  obtained  from 
a  reliable  dealer.  Many  serious  cases  of  illness  and  even 
death  have  been  caused  by  eating  oysters  so  long  dead  that 
poisonous  substances  had  formed  in  them.  Great  care  should 
also  be  taken  that  oysters  are  not  procured  from  beds  where 


168 


ANIMAL  FOODS 


the  water  has  been  contaminated  in  any  way.  "  As  it  is  in 
general  impossible  to  learn  their  origin  the  rule  of  never  eat- 
ing them  in  the  raw  state  is  adopted  by  many.  The  practice 
of  fattening  or  ^  floating '  oysters  in  fresh  or  in  brackish 
water  robs  them  of  much  of  their  fine  flavor,  and  since  the 
most  accessible  supply  of  such  water  is  at  the  outlet  of 
streams,  and  as  such  streams  are  frequently  polluted  by  sew- 
age, many  persons  believe  that  this  practice  should  be  for- 
bidden by  law.'^  ^ 

(b)  Oysters  contain  an  albuminous  substance  which  in- 
creases in  hardness  with  an  increase  of  temperature,  just  as 
the  albumin  of  an  egg  does.  When  oysters  are  cooked  with 
reference  to  this  albuminous  substance,  they  are  also  cooked 
in  the  best  possible  manner  with  reference  to  their  other  con- 
stituents; therefore  subject  them  to  a  low  temperature,  for 
a  short  time,  bearing  in  mind  that  160  to  180  degrees  Fahren- 
heit is  the  cooking  temperature  of  albumin. 

General  rule  is  to  remove  the  oyster  from  heat  as  soon 
as  the  body  grows  plump  and  the  edges  curl,  if  cooked  be- 
yond this  stage  they  are  over-cooked. 

Varieties,  In  New  York  State  the  Blue  Points  are 
considered  the  finest  for  serving  raw.  They  come  originally 
from  Blue  Point,  Long  Island. 

In  Massachusetts  the  Cove Oyster  is  considered  the  fin- 
est for  serving  raw.  They  come  from  a  still  water  cove  near 
Plymouth. 

Clams.  Clams  are  similar  in  composition  to  the  oyster 
and  same  general  rules  followed  in  preparing  and  serving. 
They  are  much  used  for  food  and  considered  a  great  delicacy. 
They  contain  a  tough  portion  that  is  not  used  in  sick-room 
cookery,  but  the  clear  juice,  on  account  of  its  digestibility 
and  stimulating  properties,  is  invaluable  in  the  sick  room. 
Clams  are  in  season  all  the  year  around. 

Varieiies,  .  There  are  two  varieties,  the  hard  and  soft  shell 
clams.    The  hard  shell  are  known  as  quahaugs.    The  small 

1  Farmer's  Bulletin  No.  375. 


OYSTERS 


169 


or  round  "  little  neck  clams  take  the  place  of  Blue  Points 
to  serve  raw  when  oysters  are  out  of  season. 

ENERGY  VALUE  OF  OYSTERS 

2  oysters   =14  Calories. 

100  grams  oysters   =50  Calories. 

1  cup  (solid)  oysters   =84  Calories. 

See  Table^  page  64^  for  energy  value  of  other  ingredients. 
RAW  OYSTERS 

Wash,  scrub  the  shells  well  under  a  stream  of  water  with 
a  vegetable  brush.  With  a  hammer  break  the  thin  edges  of 
the  shell  so  that  a  knife  may  be  inserted  to  sever  the  muscle 
which  holds  the  two  parts  of  the  shell  together :  when  this  is 
cut  remove  the  upper  half  and  wipe  the  edges  free  from  any 
grains  of  sand.  Then  sever  the  muscle  which  joins  the  oyster 
to  the  other  shell,  so  that  it  may  be  easily  lifted  out  without 
the  necessity  of  cutting.  Arrange  six  oysters  on  an  oyster- 
plate  on  crushed  ice,  and  serve  with  salt,  black  pepper  and 
lemon  juice.  A  quarter  of  lemon  cut  lengthwise  may  be 
placed  in  the  center  of  plate,  and  bit  of  parsley. 

OYSTERS  ROASTED  IN  THE  SHELL  » 

Wash  the  shells  very  carefully  with  a  brush.  Put  them 
in  a  wire  broiler  over  glowing  coals,  the  round  side  of  shell 
down  so  as  to  hold  the  juice.  Cook  them  quickly,  turning 
once  or  twice  until  the  shell  opens.  They  may  also  be  cooked 
in  a  hot  oven.  When  done  remove  the  upper  half  of  the  shell ; 
season  them  quickly  with  salt,  pepper  and  a  tiny  bit  of  but- 
ter and  vinegar,  if  liked,  and  serve  them  while  very  hot. 

The  true  oyster  flavor  is  delightfully  developed  by  pre- 
paring in  this  way.  They  may  also  be  served  with  melted 
butter,  salt,  pepper  and  lemon  juice. 

TO  WASH  OYSTERS 

Place  oysters  in  strainer  over  a  bowl  and  pour  one  table- 
spoon of  water  over  each  one-half  cup  of  oysters.  Take  each 
oyster  up  in  fingers  and  remove  any  particle  of  shell  that  may 
adhere  to  tough  muscle. 


170 


ANIMAL  FOODS 


PAN  ROAST  OYSTERS 

Wash  oysters  and  put  in  saute  pan  or  chafing  dish  and 
gently  stir  with  spoon.  When  bodies  grow  plump  and  the 
edges  curl  remove  from  heat.  Season  with  salt  and  pepper 
and  a  little  butter  and  serve  on  rounds  of  toast,  with  eighth 
of  lemon  for  individual  dishes;  or  serve  on  platter  and 
garnish  with  toast  points,  watercress  and  lemon. 

BROILED  OYSTERS,  320  CALORIES 
(Individual  Rule.) 
4  oysters.  4  teaspoons  butter. 

l^  cup  cracker  crumbs.  Salt  and  pepper. 

Select  large  oysters.  Wash,  drain  and  dry  between  towels. 
Melt  butter.  Season  cracker  crumbs  with  salt  and  pepper. 
With  silver  fork  lift  each  oyster  by  tough  muscle,  and  dip 
first  in  butter,  then  in  crumbs.  Place  on  a  buttered  fine  wire 
broiler  and  broil,  turning  often  until  brown  and  the  juice  be- 
gins to  flow.  Serve  plain,  garnished  with  parsley  and  a  piece 
of  lemon  or  prepare  cream  toast  and  sprinkle  with  fine 
chopped  celery,  and  place  the  broiled  oysters  on  top. 

CREAMED  OYSTERS,  284  CALORIES  i 

(Individual  Rule.) 
8  oysters.  %  cup  rich  milk  or  thin  cream. 

1  tablespoon  butter.  Salt. 
114  tablespoon  flour.  White  pepper. 

Wash,  drain  and  dry  oyster  between  towels.  Melt  butter 
and  remove  from  fire,  add  the  flour  and  pour  on  gradually  the 
scalded  milk.  Season  with  salt  and  pepper.  Cook  thor- 
oughly. Add  the  oysters  and  heat  until  the  edges  curl  and 
the  bodies  grow  plump.  Serve  at  once  on  rounds  of  toast 
and  garnish  with  toast  points  and  parsley  or  in  crisped  "  bread 
cases.''    See    Creamed  Fish.'^ 

CREAMED  OYSTERS  NO.  II,  340  CALORIES  2 
(Individual  Rule.) 

l^  cup  thin  cream  or  rich  milk.  1  teaspoon  butter. 

1  tablespoon  flour.  8  oysters. 

34  teaspoon  salt. 

1  Calculated  with  whole  milk. 

2  Calculated  with  thin  cream. 


OYSTERS 


Wet  the  flour  with  a  little  cold  milk ;  scald  the  cream,  add 
the  flour  and  cook  well.  Just  before  serving  add  the  drained 
oysters  and  cook  until  they  grow  plump  and  the  edges  curl; 
add  the  salt  and  butter.  Serve  in  Swedish  timbale  shells,  lit- 
tle scooped-out  buns,  or  on  rounds  of  toast. 


Prepare  the  oysters.  Stir  together  crumbs  and  melted  but* 
ter.  Butter  a  small  baking  dish  and  sprinkle  part  of  the 
crumbs  in  it.  Put  in  half  the  oysters,  sprinkle  with  salt 
and  pepper,  then  a  layer  of  crumbs,  pour  over  enough  cream 
or  oyster  liquor  to  moisten  well,  add  the  remaining  oysters, 
season,  and  finish  with  a  layer  of  crumbs  on  top.  Bake  in  a 
hot  oven  about  ten  minutes,  till  oysters  are  plump  and  crumbs 
browned.    Serve  hot. 

Never  allow  more  than  two  layers  as  they  will  not  cook 
evenly.  A  sprinkling  of  mace  or  nutmeg  is  considered  an 
improvement  by  some.  Sherry  wine  may  be  used  in  place 
of  cream. 


Scald  the  milk.  Melt  the  butter,  add  the  flour  and  pour 
on  gradually  the  scalded  milk ;  add  mace  and  onion,  and  cook 
thoroughly. 

Put  oysters  in  a  strainer  placed  over  a  bowl,  add  water  and 
carefully  pick  over  oysters  to  remove  particles  of  shell.  Heat 
liquor  which  has  drained  from  oysters  to  the  boiling  point, 
strain  through  two  thicknesses  of  cheese-cloth  and  return  to 


SCALLOPED  OYSTERS,  365  CALORIES 

(Individual  Rule.) 


14  cup  oysters.  Salt. 

%  cup  cracker  crumbs.  Pepper. 

%  cup  stale  bread  crumbs.  Yo  tablespoon  cream. 

1  tablespoon  melted  butter.  1  tablespoon  oyster  liquor. 


OYSTER  SOTJP,  252  CALORIES 

(Individual  Rule.) 


%  cup  oysters. 
l^  cup  water. 
l^  cup  milk. 
Bit  of  onion. 


1  tablespoon  butter. 
%  tablespoon  flour. 
Grating  of  mace. 
Salt  and  pepper. 


172 


ANIMAL  FOODS 


saucepan,  add  oysters  and  cook  until  plump  and  edges  curl. 
Drain  off  licjuor  and  add  to  soup.  Season,  add  oysters  and 
serve  immediately. 

OYSTER  SOUP  (FOR  THE  DIABETIC),  107  CALORIES 

(Two  Servings.) 

One-half  pint  of  oysters,  heated  in  their  own  liquor ;  strain. 
Put  in  saucepan  one-half  teaspoonful  butter  and  a  scant  half- 
teaspoonful  of  Gum  Gluten  Flour,  add  liquor,  and,  when 
slightly  thick,  oysters,  pepper  and  salt.  For  variety,  add 
occasionally  a  tablespoonful  of  cream. 

OYSTER  STEW,  205  CALORIES 

(Individual  Rule.) 
^  cup  oysters.  l^  teaspoon  salt. 

%  cup  milk.  Speck  pepper. 

%  tablespoon  water.  %  tablespoon  butter. 

Scald  the  milk.  Put  oysters  in  a  strainer  placed  over  a 
bowl,  and  add  water.  Carefully  pick  over  oysters  to  remove 
particles  of  shell.  Heat  the  liquor  which  has  drained  from 
the  oysters  to  the  boiling  point,  and  strain  through  the  finest 
strainer  and  cheese-cloth,  return  to  saucepan  and  put  in  the 
oysters  and  simmer,  but  do  not  boil,  until  they  begin  to  grow 
plump  and  the  edges  curl  and  separate.  Strain  the  liquor 
into  the  scalded  milk,  season,  add  oysters  and  serve  imme- 
diately. 

CLAMS 

ENERGY  VALUE  OF  CLAMS 

l^  dozen  clams   =40  Calories. 

31/3  ounces  clam  bouillon  =:  2  Calories. 

1  quart  clam  bouillon   =23  Calories. 

See  Table,  page  64,  for  energy  value  of  other  ingredients. 

LITTLE  NECK  CLAMS 

Serve  raw  on  the  half-shell  in  same  manner  as  raw  oysters. 
STEAMED  CLAMS 

For  steaming,  clams  should  be  bought  in  the  shell.  Wash 
in  several  waters,  scrubbing  thoroughly.    Put  into  kettle. 


CLAMS 


173 


allowing  one-fourth  cup  water  to  one  quart  clams.  Cover 
closely  and  steam  until  clams  partially  open.  Care  should 
be  taken  not  to  overcook  them.  Serve  with  melted  butter.  A 
few  drops  of  lemon  juice  may  be  added  to  butter. 

CLAM  BROTH 

(Individual  Rule.) 
1  dozen  clams.  2  tablespoons  cold  water. 

Wash  clams  and  scrub  with  a  brush,  changing  the  water 
several  times.  Put  in  saucepan,  add  water,  cover,  and  cook 
until  shells  open.  Eemove  clams  from  shell,  adding  liquor 
which  comes  from  them,  to  liquor  already  in  saucepan. 
Strain  liquor  through  double  thickness  of  cheese-cloth.  Serve 
hot,  cold,  or  frozen. 

CLAM  WATER 

(Individual  Rule.) 
%  cup  cold  water.  Clam  Broth. 

To  the  water  add  the  required  amount  of  the  clam  broth 
to  make  the  strength  desired.  Serve  hot,  cold,  or  frozen. 
When  necessary,  serve  in  small  quantity  and  repeat  at  short 
intervals. 

Note. —  Clam  broth  served  in  the  several  ways  (as  a 
variety)  is  invaluable  in  case  of  weak  stomach,  indigestion 
and  general  debility. 

CLAM  WATER  NO.  II,  17  CALORIES 

(Individual  Rule.) 
1/4  cup  Clam  Broth.  Pepper. 
1  tablespoon  milk.  %  teaspoon  butter. 

l^  cup  hot  water. 

Blend  the  clam  broth,  milk  and  hot  water,  season  with 
pepper  and  add  the  butter.    Serve  hot. 

Note. —  The  pepper  and  butter  may  be  omitted  when  neces- 
sary. 


174 


ANIMAL  FOODS 


CLAM  STEW,  250  CALORIES 

(Individual  Rule.) 

l^  cup  clam  broth.  %  teaspoon  salt. 

V2  cup  scalded  milk.  Speck  pepper. 

1  tablespoon  butter.  Soft  part  of  1  dozen  clams. 

^^  tablespoon  flour. 

Melt  buttei%  add  flour^  add  gradually  the  scalded  milk  and 
clam  broth,  and  cook  thoroughly.  Season,  add  clams  and 
serve  hot. 

CLAM  SOTJP,  276  CALORIES 

(Individual  Rule.) 

%  dozen  clams.  l^  tablespoon  butter. 

%  cup  cold  water.  l^  tablespoon  flour. 

1  cup  milk.  Salt  and  pepper. 

Wash  and  scrub  clams  and  put  in  kettle  with  cold  water. 
Cook  until  shells  open.  Take  from  shell  and  cut  off  the 
tough  parts ;  save  the  soft  parts  for  the  soup  and  keep  warm. 
Scald  the  milk.  Melt  the  butter,  add  the  flour  and  pour 
on  gradually  the  hot  milk.  Cook  thoroughly;  add  soft  parts 
of  clams  and  juice,  season  with  salt  and  pepper,  and  serve 
immediately  and  hot. 

CLAM  BOUILLON,  45  CALORIES 

(Two  Servings.) 
%  cup  cold  water.  Salt. 
%  cup  clam  broth.  Pepper. 
Ys  cup  scalding  milk.  Celery  sauce. 

l^  teaspoon  butter.  White  of  egg  or  whipped  cream. 

Blend  the  water  and  clam  broth,  heat  to  the  boiling  point, 
then  add  the  scalding  milk,  the  butter,  and  stir  well;  season 
with  salt,  pepper  and  celery  sauce  to  taste.  A  small  quan- 
tity of  cracker  crumbs  may  be  added  to  thicken  it.  Serve  in 
heated  bouillon  cups  and  garnish  with  two  teaspoons  of 
whipped  cream  or  well-beaten  white  of  egg. 


EGGS 


175 


CIAM  BOUILLON  BISQUE,  355  CALORIES 

(Two  Servings.) 
%  tablespoon  butter.  tablespoon  flour. 

1  tablespoon  chopped  onion.  1  cup  boiling  water. 

l^  tablespoon  chopped  carrot.      Yolk  1  egg. 
1  cup  clam  broth.  l^  cup  cream. 

Melt  the  butter,  add  the  finely  chopped  onion  and  carrot, 
cover  and  cook  until  the  onion  and  carrot  are  tender,  stirring 
it  occasionally.  Add  the  flour,  blending  well;  then  pour  on 
gradually  the  boiling  w^ater  and  the  clam  broth.  Cook  five 
minutes,  strain  and  return  to  saucepan.  Mix  the  yolk  of  egg 
with  the  cream,  and  add  it  slowly  to  the  Bisque.  Pour  into 
heated  bouillon  cups,  and  serve  with  small  oyster  crackers. 

ALBUMINIZED  CLAM  WATER 

See  "  Albuminized  Beverages    for  recipe.    Page  123. 

CLAM  BROTH  NO.  II 
See  "  Meat  Broth  and  Jellies for  recipe.    Page  220. 

CLAM  BROTH  ON  TOAST 
See  "  Toast    for  recipe.    Page  258. 

CLAM  FRAPPE 
See    Ices    for  recipe.    Page  313. 

CLAM  SHERBET 
See  "  Sherbets  "  for  recipe.    Page  312. 

EGGS  1 

Many  kinds  of  eggs  are  eaten,  but  hens'  eggs  are  the  only 
ones  necessary  of  consideration  as  a  staple  article  of  diet. 
The  shell  constitutes  about  1.1  per  cent,  of  the  weight  of  the 
whole  egg,  the  yolk  32  per  cent.,  and  the  white  57  per  cent. 

Composition,  Eggs  are  albuminous  in  nature  and  con- 
sist practically  of  the  following  substances  —  protein,  water, 
fat  and  mineral  matter.  The  composition  of  the  hen's  egg  is 
as  follows: 


1  For  further  information,  note  "Eggs  and  Their  Uses  as  Food."  Farm- 
er's Bulletin  No.  128,  U.  S.  Dept.  of  Agriculture,  Washington,  D.  C. 


176 


ANIMAL  FOODS 


Fuel  value 

Refuse    Water    Protein      Fat      Ash  per  pound 

calories 

Whole  egg  as  purchased.  .  .12.2%  65.5%  11.9%  9.3%  0.9%  635 
Whole  egg,  edible  portion.  .  73.7%     13.4%     10.5%     1.0%  720 

White    86.2%     12.3%      0.2%     0.6%  250 

Yolk    49.5%     15.7%     33.3%     1.1%  1705 

From  this  table  it  may  be  seen  that  the  white  of  egg  con- 
sists of  eight-tenths  water,  the  remaining  portion  being  prin- 
cipally protein  (albumin),  with  a  little  mineral  matter,  etc., 
the  yolk  is  about  half  water,  one-third  fat,  and  nearly  one- 
sixth  protein,  with  almost  twice  as  much  mineral  matter  as 
the  white. 

Varieties.  By  eggs  the  product  of  the  domestic  fowl  are 
commonly  meant.  The  eggs  of  the  duck,  goose,  turkey,  etc., 
are  edible,  but  are  hardly  suited  for  the  sick,  because  of  their 
stronger  flavor.  The  purely  white  eggs  are  usually  selected 
for  the  invalid,  but  many  regard  the  brown-shelled  egg  as  the 
more  delicate. 

Digestibility.  Eggs  are  easily  digested  and  very  thoroughly 
absorbed  in  the  intestines.  If  the  absorption  is  delayed,  de- 
composition follows  with  production  of  sulphuretted  hydrogen 
and  ammonia,  which  causes  considerable  gastro-enteric  disturb- 
ance. The  yolk  is  usually  the  cause  of  this  disturbance.  The 
digestibility  of  an  egg  depends  upon  its  freshness  and  the 
manner  in  which  it  is  cooked.  ^  Carelessness  in  cooking  and 
serving  may  make  an  egg  difficult  of  digestion  and  un- 
appetizing, when,  if  it  is  cooked  properly,  it  would  be  more 
palatable  and  easy  of  digestion.  A  raw  egg,  on  account  of  its 
blandness,  does  not  stimulate  the  flow  of  gastric  juice  and  is 
not  as  easily  digested  as  a  soft-cooked  egg;  but  by  heating  a 
raw  egg  the  albumin  is  finely  divided  and  is  more  quickly 
acted  upon  by  gastric  juice,  consequently  is  digested  about 
as  quickly  as  a  soft-cooked  egg.  Eaw  eggs  are  added  to 
various  foods,  as  milk  and  broth,  etc.,  to  give  extra  nutriment. 
Eggs  are  freely  prescribed  for  those  suffering  from  loss  of 
flesh  and  strength,  as  the  convalescent,  anaemic,  or  in  tubercu- 


1  See  Albumin,  p.  11. 


EGGS 


losis;  in  such  cases  as  many  as  twelve  eggs  being  given  in  as 
many  hours. 

A  soft-cooked  egg  digests  very  quickly. 

A  medium-cooked  egg  is  not  as  easily  digested  as  either 
the  raw,  soft  or  hard-cooked,  and  should  not  be  served  cooked 
in  this  manner  to  the  sick. 

A  hard-cooked  egg  as  commonly  cooked  is  difficult  to  di- 
gest, but  cooked  at  proper  temperature  and  chopped  very  fine 
will  digest  about  as  quickly  as  a  soft-cooked  egg. 

Nutritive  Value,  Eggs  are  a  very  nutritious  food,  com- 
parable with  meat,  milk,  cheese,  and  other  animal  foods,  both 
as  regards  total  food  material  and  the  total  protein  and  fat 
furnished  by  them.  At  twenty-five  cents  per  dozen  they  are 
commonly  considered  very  expensive,  but  this  must  not  be 
interpreted  too  literally.  Many  persons  will  be  satisfied  with 
an  egg  who  would  not  be  with  the  equivalent  food  value  in 
the  form  of  meat,  and  eggs  are  valuable  for  giving  varietj 
to  the  diet  and  for  furnishing  an  easily  digested  protein  food, 
especially  for  the  sedentary.  For  children  they  are  much 
better  than  meat,  because  the  fat  is  in  an  emulsified,  and 
hence  easily  digested  form,  and  because  of  their  ash  con- 
stituents. The  yolk  is  rich  in  compounds  of  iron,  phosphorus, 
calcium,  magnesium.  The  protein  of  egg  yolk  is  combined 
with  lecithin,  a  phosphorized  fat  which  has  come  to  be  re- 
garded as  an  important  constituent  of  food,  especially  for  the 
growing  animal.  Egg  yolks  are  frequently  prescribed  for 
invalids  requiring  an  easily  assimilated,  concentrated  food. 
It  should  be  remembered  that  when  fat  is  barred  from  the 
3iet,  egg  yolk  should  not  be  given. 

Egg  white  is  valuable  chiefly  as  a  source  of  protein.  Be- 
cause of  its  mild  flavor  it  can  be  combined  with  many  sub- 
stances, especially  milk  and  other  beverages  (See  "Al- 
buminous Beverages,'^  page  118),  to  increase  the  nutritive 
value  of  a  liquid  or  semi-solid  diet. 

With  some  persons,  eggs  induce  constipation,  or  have  a 
slight  aphrodisiac  effect.  They  contain  sulphur,  and  unless 
digested  before  decomposition  occurs  in  the  alimentary  tract, 


178 


ANIMAL  FOODS 


give  rise  to  hydrogen  sulphide  gas.  They  should  not  be  eaten 
by  those  suffering  from  flatulent  dyspepsia,  gastric  dilatation, 
or  any  severe  gastric  derangen;ent.  They  are  contraindicated 
in  acute  Bright's  disease. 

Principles  to  be  Observed  in  CooTcing.  The  principal  con- 
stituent of  the  egg  is  albumin,  which  should  be  cooked  in 
such  a  manner  as  to  require  the  least  possible  expenditure  of 
force  in  digestion.  Those  who  are  ill  cannot  afford  to  waste 
energy,  and  whether  they  are  forced  to  do  so  or  not  depends 
much  upon  those  who  prepare  their  food. 

Effect  of  Temperature  on  Albumin,  See  "  Albumin/^  page 
11. 

The  proper  cooking  temperature  of  egg  albumin  is  160  to 
180  degree  Fahrenheit,  when  it  is  found  to  be  tender,  soft, 
jelly-like,  and  in  an  easily  digested  state. 

But  cooked  at  the  boiling  point  of  water,  212  degrees 
Fahrenheit,  albumin  is  found  to  be  firm,  compact,  tough  and 
indigestible.  "With  this  knowledge  we  can  appreciate  the 
necessity  of  cooking  eggs  at  a  temperature  below  that  of  boil- 
ing water.  It  is  often  advisable  to  cook  the  white  and  yolk 
of  eggs  separately,  as  the  yolk  when  hard  cooked  (at  proper 
temperature)  and  mealy  is  more  easily  digested  than  the 
soft  cooked  yolk,  and  the  white  more  easily  digested  soft 
cooked. 

Suggestions.  Eggs  should  be  kept  in  a  cool,  dry  place. 
Always  wash  eggs  just  before  using.  Save  the  shell  for  mak- 
ing boiled  coffee,  as  the  shells  of  three  eggs  is  as  effective  in 
settling  coffee  as  one  whole  egg.  When  using  several  eggs 
break  them  separately  in  a  saucer  to  test  the  quality  of  each. 

In  beating  fresh  eggs  to  a  stiff  froth  the  albumin  entraps 
the  air,  forming  bubbles  which  expand  and  stiffen  when  ex- 
posed to  heat  and  blended  with  batter  and  dough,  thus  mak- 
ing the  food  light  and  spongy.  Stale  eggs  lose  this  quality 
of  f  rothiness. 

Test  for  Fresh  Eggs.  (1)  The  shell  of  a  fresh  egg  is 
slightly  rough ;  held  to  the  ear  and  shake  slightly  there  should 
be  little  sound,  held  in  front  of  electric  light  or  candle  in 


EGGS 


179 


a  dark  room  if  they  look  more  transparent  in  center  they  are 
fresh^  if  more  transparent  at  ends,  are  stale. 

(2)  In  a  solution  made  of  two  ounces  of  common  salt  and 
one  pint  of  water,  an  egg  one  day  old  will  sink  (not  quite 
reach  the  bottom)  ;  three  days  old  will  barely  float  above  the 
surface,  and  seven  days  old  will  float  above  the  surface.  This 
is  due  to  the  loss  of  water  and  to  the  development  of  gases  of 
putrefaction.  Unless  air  is  excluded  from  eggs  they  very 
quickly  deteriorate  in  value  and  decompose. 

The  water  in  the  egg  evaporates  through  the  shell,  which 
is  porous,  and  air  rushes  in  to  take  its  place,  causing  decompo- 
sition of  the  organic  matter  of  the  egg,  the  result  being  the 
formation  of  various  gases  —  principally  sulphuretted  hydro- 
gen, due  to  the  action  of  putrefactive  bacteria  which  enter 
the  shell  with  air.  Eggs  eaten  in  this  state  may  cause  gastric 
and  intestinal  disorders,  therefore,  unless  eggs  are  perfectly 
fresh,  they  should  not  be  given  to  a  child  or  a  person  of 
delicate  digestion  or  the  sick. 


See  Table,  page  64,  for  energy  value  of  other  ingredients. 


Wash  one  egg  and  put  it  in  a  small  saucepan  of  boiling 
water  to  cover;  remove  to  back  of  stove,  or  where  the  water 
will  keep  very  hot,  but  not  boil.  Cook  seven  to  ten  minutes, 
according  to  consistency  desired.  Serve  in  slightly  heated 
cups. 

Xote. —  A  stone  crock  is  nice  to  use,  as  it  keeps  more  even 
heat.  A  double  boiler  may  be  used,  putting  boiling  water 
in  top  and  bottom,  set  on  back  of  stove  and  cook  six  to  seven 
minutes,  according  to  size  of  egg. 

Care  must  be  taken  that  the  size  of  utensil  is  in  accordance 
with  the  number  of  eggs  to  be  cooked,  so  that  the  cold  eggs 


ENERGY  VALUE  OF  AN  EGG 


1  average  egg   

1  average  white  of  egg 
1  average  yolk  of  egg 


=  60  Calories. 
1=:  13  Calories. 
=:48  Calories. 


SOFT  COOKED  EGGS 


180 


ANIMAL  FOODS 


will  lower  the  temperature  of  the  boiling  water.  Keep  tem- 
perature about  160  degree  Fahrenheit,  or  a  little  above. 

SOFT  COOKED  EGGS  NO.  II 

Wash  one  egg  and  put  it  in  a  small  saucepan  of  cold  water 
to  cover.  Bring  just  to  boiling  point,  remove  and  serve  in 
slightly  heated  cups. 

HARD  COOKED  EGGS 

Follow  directions  for  soft. cooked  eggs  No.  I,  allowing  egg 
to  remain  in  water  forty-five  minutes.  .  Chop  fine  and  add 
one-half  teaspoon  butter  and  a  few  grains  salt,  serve  in 
slightly  heated  cups. 

STEAMED  EGGS 

Butter  an  egg  shirrer  or  a  small  sauce-plate  and  pour  in 
the  eggs.  Salt,  place  in  steamer  over  boiling  water,  and 
cook  till  white  is  firm.  Cooked  in  this  manner,  the  white  is 
tender  and  light  and  can  be  eaten  by  invalids. 

BAKED  EGGS 

Plain  baked  eggs  make  a  pretty  breakfast  dish.  Take  a 
deep  earthen  plate,  butter  it  and  break  in  the  eggs,  adding 
salt,  pepper,  bits  of  butter,  and  bake  in  a  moderate  oven  until 
the  white  is  set.  Garnish  with  curled  parsley  and  serve  with 
buttered  toast.    Use  a  small  dish  to  prepare  one  egg. 

Note. —  Before  cooking  I/2  tablespoon  of  cream  to  each 
egg  may  be  poured  over  them,  and  in  serving  a  little  grated 
cheese  may  be  sifted  over  the  top. 

BAKED  EGGS  (FOR  THE  DIABETIC) 

Break  an  egg  into  a  baking-cup,  pour  gently  over  it  a  large 
tablespoonful  of  melted  butter  sauce;  then  add  a  thick  layer 
of  grated  cheese;  sprinkle  with  Gum  Gluten  cracker  crumbs, 
and  dot  with  bits  of  butter.  Bake  until  the  egg  is  set,  and 
serve  at  once. 


EGGS 


181 


GOLDEN-ROD  EGGS 

1  hard-cooked  egg  =  60  Calories.  2  slices  toast  =  146  Calories. 

Sauce  =170  Calories. 

2  teaspoons  butter.  Speck  white  pepper. 
1/2  tablespoon  flour.  Salt. 

^  cup  scalded  milk. 

Prepare  the  sauce.  Add  the  white  of  egg  chopped  fine,., 
pour  over  the  toast  and  rub  the  yolk  through  a  strainer  over 
the  top.    Serve  at  once. 

Sauce.  Melt  butter,  add  flour  and  gradually  the  scalded 
milk;  cook  well  and  season  with  salt  and  pepper. 

EGG  NESTS,  142  CALORIES 

1  egg.  1    round    of   toast   with  toast 

teaspoon  butter.  points. 
Salt  to  taste. 

Toast  bread.  Separate  egg.  Beat  white  to  a  stiff  froth. 
Salt  to  taste.  Spread  toast  with  butter  and  put  white  of  egg 
on  in  shape  of  nest.  Make  a  depression  in  center,  put  in  the 
butter  and  drop  the  yolk  in  the  hollow.  Cook  in  a  moderate 
oven  three  or  four  minutes. 

Note. —  May  be  cooked  in  tumbler  placed  in  pan  of  water, 
allowing  the  water  to  heat  gradually,  and  as  the  white  rises, 
make  a  depression  and  drop  in  yolk. 

It  may  be  served  with  Tomato  Sauce.  ^ 

FOAMY  OMELET,  144  CALORIES 

1  egg.  %  saltspoon  salt.  \ 

1  tablespoon  milk.  Speck  pepper.  \ 

2  teaspoons  butter. 

Separate  egg  and  beat  white  to  a  stiff  froth.  Beat  yolk:.^> 
till  light,  add  milk,  salt  and  pepper;  lightly  fold  the  yolk/ 
into  the  white.  Put  butter  into  saute  pan,  when  it  bubbles 
pour  in  the  mixture.  Gently  shake  pan  so  omelet  will  not 
adhere  to  it;  lift  up  at  sides  with  a  knife  to  see  when  done, 
and  when  a  delicate  brown  set  pan  in  oven  a  minute  to 
absorb  moisture  on  top.  Fold  omelet  half  over,  turn  on  a 
hot  dish,  and  serve  immediately. 


183 


ANIMAL  FOODS 


Variations.  Mix  one  tablespoon  ham,  or  any  meat, 
chopped  fine,  with  foamy  omelet,  and  cook  as  directed.  Or 
when  omelet  is  cooked,  the  chopped  meat  may  be  spread  over 
before  folding.  A  little  chopped  parsley  may  be  added.  Oys- 
ters either  whole  or  chopped,  or  creamed  chicken,  stewed  or 
sliced  tomatoes,  asparagus  tips,  peas  or  jelly  may  be  used. 

BAKED  MEAT  OMELET 

Prepare  Foamy  Omelet  and  add  to  it  the  chopped  meat. 
Put  it  into  a  buttered  pudding-dish,  set  it  in  a  pan  of  hot 
ivater  and  bake  until  firm. 

BREAD  OMELET,  164  CALORIES 

2  tablespoons  bread  crumbs.         Speck  pepper. 

2  tablespoons  milk.  1  egg. 

Speck  salt.  1  teaspoon  butter. 

Soak  bread  crumbs  in  the  cold  milk  for  ten  minutes,  add 
the  salt  and  pepper.  Separate  egg  and  beat  until  light.  Add 
the  crumbs  and  milk  to  the  yolk  and  fold  in  the  white.  Fol- 
low general  directions  as  for  Foamy  Omelet. 

POACHED  OR  DROPPED  EGGS 

Toast  a  square  or  round  piece  of  bread  and  four  toast 
points ;  put  on  hot  plate  with  points  at  each  side  and  garnish 
with  a  sprig  of  parsley.  Have  a  shallow  pan  two-thirds  full 
of  boiling  salted  water,  allowing  one  teaspoon  salt  to  one  pint 
w^ater.  Put  a  slightly  buttered  muffin  ring  on  a  buttered 
skimmer  in  the  water.  Break  an  egg  into  the  ring.  The 
water  should  cover  the  egg.  When  there  is  a  film  on  top  and 
the  white  is  firm,  carefully  take  up  skimmer,  remove  ring, 
loosen  egg  with  a  knife  and  place  on  the  toast;  salt  slightly. 
The  toast  may  be  buttered  if  desired. 

EGG  POACHED  IN  MILK,  470  CALORIES 

1  egg.  Salt. 

teaspoons  butter.  2  tablespoons  grated  cheese. 

%  cup  thin  cream. 

Melt  butter  in  top  of  double  boiler,  add  cream  and  when 
hot  drop  in  carefully  the  egg.    Cook  until  white  is  nearly 


EGGS 


183 


firm,  add  salt  and  sprinkle  with  cheese.  Serve  on  toast. 
Cheese  may  be  omitted. 

CODDLED  OR  SCRAMBLED  EGGS,  180  CALORIES 

1  egg.  1  saltspoon  salt. 

l^  cup  milk.  Speck  pepper. 

1  teaspoon  butter. 

Beat  egg  in  top  of  double  boiler  until  lights  add  milk  and 
rest  of  ingredients  and  stir  over  boiling  water  until  it  thick- 
ens; allow  it  to  stand  a  few  minutes  without  stirrings  to  set. 
Serve  on  toast  or  hot  rice. 

EGG  SANDWICHES,  96  CALORIES 

1  hard-cooked  egg.  %  teaspoon  mustard. 

l^  teaspoon  salt.  3  drops  vinegar. 

Speck  paprika.  1  teaspoon  butter. 

Mince  the  egg  very  fine  with  a  silver  fork,  add  seasonings 
and  butter,  and  mix  thoroughly.  Butter  very  thin  slices  of 
bread,  spread  with  egg  mixture,  cover  it  with  watercress 
leaves,  or  bits  of  nasturtium  leaves,  or  lettuce.  Cover  with 
another  slice  of  bread,  and  cut  in  triangles  or  rounds.  Serve 
on  small  plate  and  doily. 

Note. —  Minced  ham  may  be  added  to  egg  mixture. 

SHIRRED  EGGS 

Butter  an  egg  shirrer,  ramikins,  or  small  earthen  cups; 
put  one  egg  in  each  without  breaking  yolk ;  dust  with  salt  and 
white  pepper,  put  in  pan  of  hot  water  and  cook  on  back  of 
range  or  in  a  moderate  oven  until  white  is  set.  If  baked,, 
cover  with  a  buttered  paper  to  keep  from  browning. 

SHIRRED  EGGS  NO.  II 

Butter  small,  deep  earthen  dishes  and  line  with  fine  white 
bread  crumbs  moistened  to  a  paste,  and  seasoned  with  salt 
and  pepper.  Break  an  egg  in  each,  sprinkle  with  a  few  grains 
of  salt,  cover  with  more  paste  and  bake  in  a  pan  of  hot  water^ 
placed  in  the  oven.  When  egg  is  set,  serve  with  two  table- 
spoons of  tomatoes  or  cream  sauce  poured  over  it^  and  garnish 
with  a  sprig  of  parsley. 


184 


ANIMAL  FOODS 


FILLED  EGGS,  96  CALORIES 

1  hard-cooked  egg.  %  teaspoon  mustard. 

1  teaspoon  butter  or  Paprika. 
1  teaspoon  olive  oil.  Salt. 

Eemove  the  shell  and  cut  the  egg  in  halves  lengthwise. 
Take  out  the  yolk  carefully  without  breaking  the  white.  Eub 
the  yolk  to  a  smooth  paste^  adding  the  butter  or  oil  and  the 
seasonings^  and  mix  thoroughly.  A  small  quantity  of  finely 
chopped  ham^  tongue  or  chicken  may  be  added.  Fill  the 
whites  with  the  mixture  and  serve  on  lettuce^,  or  in  a  bed  of 
parsley. 

EGG  DESSERTS 

See  "  Nutritious  Desserts  ^'  for  recipe.    Page  386. 

ALBUMINOUS  BEVERAGES 

See  "Albuminous  Beverages    for  recipe.    Page  118. 

MILK  AND  MILK  PRODUCTS^ 

Milk  is  the  only  substance  in  nature  designed  expressly  for 
the  nourishment  of  the  young  animal.  It  contains  all  the 
compounds  necessary  to  support  life^  in  remarkably  good  pro- 
portions and  in  very  assimilable  forms.  It  is  a  perfect  food 
for  infants,  and  is  specially  suited  to  the  needs  of  certain 
classes  of  invalids  and  sedentary  persons.  For  the  active 
adult  it  is  undesirable  as  the  sole  article  of  diet,  because  the 
proportion  of  water  is  so  high  that  large  quantities  have  to 
be  taken  to  supply  the  necessary  energy;  because  the  propor- 
tion of  protein  is  unnecessarily  high ;  and  because  it  furnishes 
no  indigestible  residues  to  supply  bulk  for  the  perfect  func- 
tioning of  the  intestines. 

Composition,  Milk  contains  the  five  food  principles,  the 
proportions  varying  somewhat  with  different  species,  and  also 
with  individuals  of  the  same  species.  Cow's  milk,  which  is 
most  extensively  used,  is  the  only  kind  which  will  be  con- 
sidered here.    Milk  has  a  specific  gravity  of  1.027  to  1.035. 

1  For  further  information,  note  "The  Use  of  Milk  as  Food,"  Farmer's 
Bulletin  No.  363,  U.  S.  Dept.  of  Agriculture,  Washington,  D.  C. 


MILK  AND  MILK  PRODUCTS 


185 


The  chief  bulk  is  water,  which  averages  87  per  cent.  The 
solid  matter  is  made  up  of  proteins,  fats,  carbohydrates  and 
mineral  matter.  The  average  percentages  are  as  follows: 
Protein,  3.3  per  cent.;  fat,  4  per  cent.;  carbohydrates,  5  per 
cent;  mineral  matter,  0.7  per  cent. 

The  principal  protein  is  casein,  a  compound  containing 
both  phosphorus  and  sulphur.  Casein  is  precipitated  (or 
coagulated)  by  the  addition  of  acid  or  in  neutral  solutions, 
by  rennet.  Milk  also  contains  lactalbumin,  arranging  about 
1/7  of  the  total  protein.  The  character  of  the  curd  depends 
largely  on  the  relative  proportions  of  casein  and  lactalbumin. 

The  fat  of  milk  varies  widely  in  amount.  It  is  found 
throughout  the  milk  in  globules,  i.  e.,  as  an  emulsion.  On 
standing,  the  fat  rises  to  the  top  and  forms  cream  chemically. 
Several  fats  are  present,  chiefly  stearin,  palmitin  and  olein^ 
with  smaller  amounts  of  others,  which  give  the  characteristic 
flavor  to  butter.  The  chief  carbohydrate  is  lactose  or  milk 
sugar.  This  remains  in  the  whey  when  the  casein  and  fat 
are  removed. 

The  ash  constituents  are  mainly  phosphates  and  chlorides- 
of  calcium,  sodium  and  potassium. 

Digestibility.  AA^hile  milk  is  taken  as  a  liquid,  it  should 
really  be  regarded  as  a  solid  food,  for  in  the  stomach  it  i& 
coagulated  by  the  action  of  the  enzyme  rennin  in  the  gastric 
juice.  If  the  milk  is  swallowed  hastily,  a  large,  tenacious 
curd  may  form,  which  will  remain  long  in  the  stomach,  and 
the  milk  will  be  regarded  as  difficult  of  digestion.  If  the 
milk  is  sipped  slowly  —  or  eaten  with  a  spoon  —  the  curds  will 
be  small,  and  hence  readily  acted  on  by  the  gastric  juice. 
For  this  reason,  the  combination  of  milk  with  another  food 
material,  as  bread  or  cereal  gruel,  may  render  it  more  easily 
digestible.  Many  persons  think  that  they  cannot  digest  milk. 
This  is  seldom  true,  if  the  above  precautions  are  taken. 

Nutritive  Value,  Milk  is  a  high  protein  food.  In  infancy 
it  therefore  furnishes  the  nitrogen  necessary  for  the  forma- 
tion of  new  protoplasm.  Throughout  the  growing  period,  it 
furnishes  the  most  valuable  source  of  protein,  as  it  is  non- 


186 


ANIMAL  FOODS 


stimulating,  and  less  liable  to  putrefaction  in  the  alimentary 
tract  than  meat  proteins.  Given  a  quart  of  milk  and  an  egg 
each  day,  a  child  under  eight  years  of  age  on  a  suitable  diet 
of  proper  fuel  value,  will  have  sufficient  protein  for  all  body 
needs. 

The  fat  of  milk,  being  in  an  emulsified  form,  is  more 
readily  digested  than  the  fat  of  meats  and  other  similar  foods. 
The  carbohydrates  of  milk  require  only  transformation  to 
simple  sugars  by  the  intestinal  enzyme  lactase,  to  be  per- 
fectly utilized.  Often  the  energy  value  of  milk  is  increased 
for  infants  and  invalids,  by  addition  of  this  soluble,  mild- 
flavored  compound. 

The  ash  of  milk  contains  the  elements  required  for  the 
bony  tissues  in  particularly  assimilable  forms.  It  is  lack- 
ing in  iron,  so  that  this  element  must  be  supplied  by  other 
foods  (as  yolk  of  egg)  when  milk  is  the  chief  source  of  nutri- 
ment. 

The  value  of  milk  as  a  food  is  not  appreciated  by  many 
people.  It  is  frequently  regarded  as  a  beverage  rather  than 
nutriment,  while  in  fact  a  quart  of  milk  is  equivalent  in  food 
value  to  half  a  loaf  of  bread  (six  ounces)  or  three-quarters  of 
a  pound  of  lean  beef.  It  contains  as  much  protein  as  one- 
third  of  a  pound  of  lean  beef,  at  approximately  the  same 
price,  and  in  addition  about  as  much  fat  as  is  daily  con- 
sumed at  the  table  in  the  form  of  butter,  over  one  and  one-half 
ounces  of  milk  sugar,  and  valuable  mineral  salts.  Compared 
with  other  animal  foods  milk  is  a  cheap  food,  even  at  10  or  12 
cents  per  quart,  and  should  enter  freely  into  the  dietary.  It 
need  not  be  used  as  a  beverage  if  disliked,  but  can  be  combined 
with  other  materials  in  soups,  sauces  for  vegetable,  custards 
and  the  like,  or  used  in  cooking  cereals,  in  place  of  water. 

The  value  of  skim  milk  as  a  food  also  needs  to  be  empha- 
sized. It  has  lost  most  of  the  fat  in  the  skimming  processes, 
but  is  correspondingly  richer  than  whole  milk  in  protein, 
carbohydrates  and  ash.  It  is  not  as  rich  in  flavor  as  whole 
milk,  but  used  in  combination  with  other  foods  it  forms  a 
very  inexpensive  source  of  valuable  nutriment,  two  and  one- 


MILK  AND  MILK  PRODUCTS 


187 


half  quarts  of  skim  milk  will  yield  as  much  protein  as  a 
pound  of  lean  round  steak,  at  less  than  one-fourth  the  cost. 

Care  of  milk.  The  importance  of  keeping  milk  clean  can- 
not be  over-emphasized.  Aside  from  all  esthetic  considera- 
tions, absolute  cleanliness  is  essential  as  a  protection  to 
health.  Milk  is  an  excellent  culture  medium  for  bacteria,  and 
these  organisms  may  not  only  be  of  types  producing  changes 
in  the  character  of  the  milk,  such  as  alterations  in  flavor, 
odor,  color,  decomposition  of  proteins,  formation  of  gases, 
alcohol,  lactic  acid,  etc.,  but  also  disease  germs,  especially 
those  of  tuberculosis,  scarlet  fever,  typhoid  fever,  and  diph- 
theria. 

Commercially,  care  of  milk  is  important  as  effecting  the 
keeping  qualities.  For  all  these  reasons,  milk  should  come 
from  a  healthy  animal  in  a  sanitary  environment.  Milking 
must  be  done  under  conditions  which  protect  the  milk  as 
fully  as  possible  from  contamination  through  impurities  on 
the  cow  herself,  on  the  hands  or  clothing  of  the  milker,  in 
the  receptacles  used  for  the  milk,  and  in  the  air,  in  the  place 
where  the  milking  is  done.  Milk  should  be  immediately 
cooled,  and  transported  to  the  consumer  in  sealed  bottles; 
cooling  prevents  the  growth  of  bacteria.  Such  cautions 
necessarily  increase  the  price  of  milk,  but  even  then  milk  is 
a  cheap  food  and  the  additional  security  is  worth  paying 
for. 

Certification  of  Milk.  To  insure  a  milk  free  from  im- 
purities, the  method  of  certification  and  pasteurization  have 
been  widely  adopted. 

Certification  involves  a  specific  testing  of  milk  against  all 
accidental  and  harmful  contamination.  To  secure  it  the 
services  of  chemists,  bacteriologists  and  veterinary  surgeons 
are  required.  The  most  vital  object  desired  is  the  exclusion 
of  tubercule  bacilli  from  milk,  which  involves  a  special  in- 
spection of  dairy  herds  and  rejection  of  tuberculous  cows. 
Other  pernicious  germs,  pus  corpuscles,  etc.,  are  also  sought 
for. 

Certification  of  milk  requires  periodical  inspection  of 


188 


ANIMAL  FOODS 


dairies,  of  bottled  milk  bought  in  open  market,  etc.  All  milk 
must  correspond  to  a  number  and  variety  of  tests,  too  numer- 
ous to  be  mentioned  in  this  connection.  Every  branch  of 
the  milk  trade  is  covered.  Such  milk  receives  a  certificate 
which  should  contain  the  date  of  milking  and  is  naturally  ex- 
pensive, but  it  should  be  used  whenever  possible  for  infants 
and  little  children,  and  for  all  purposes  in  households  which 
buy  the  best  grades  of  other  food  materials. 

Pasteurization.  This  is  the  process  by  which  milk  is  ren- 
dered more  or  less  sterile  through  destruction  of  active  bac- 
teria by  heat.  Various  standards  as  to  temperature  and 
time  have  been  adopted,  but  in  general  the  milk  is  heated 
to  a  temperature  not  exceeding  167°  P.,  for  a  period  of  20  to 
45  minutes,  and  then  rapidly  cooled  to  45°  F.  or  lower. 
Most  harmful  bacteria  and  lactic  acid  bacteria  are  killed. 
Spores  are  not  killed,  and  if  the  milk  is  not  kept  cold  or  is 
allowed  to  stand  too  long,  putrefactive  organisms  develop. 
These  putrefactive  changes  are  very  undesirable,  so  that  the 
care  of  pasteurized  milk  is  just  as  important  as  that  of  fresh 
milk.  If  carelessly  handled,  the  fact  that  it  does  not  sour 
readily  is  a  menace  to  health  rather  than  a  benefit. 

Commercial  pasteurization  is  a  cheap  and  effective  means  of 
preventing  the  spread  of  ordinary  infectious  diseases.  The 
degree  of  heat  used  does  not  change  materially  the  flavor  nor 
the  chemical  composition  of  the  milk.  It  does  destroy  the 
enzymes  naturally  present  in  milk,  and  how  much  this  affects 
the  value  of  milk  for  infants  is  still  unsettled.  When  clean 
fresh  milk  cannot  be  absolutely  insured,  it  is  safer  to  pas- 
teurize. But  this  process  cannot  make  bad  milk  good  nor 
dirty  milk  clean.  If  bacteria  have  already  produced  poison- 
ous products  it  will  not  destroy  them. 

Sterilization,  Sterilization  is  accomplished  by  keeping 
milk  at  boiling  temperature  (212°  F.)  for  10  or  more  minutes, 
preferably  in  the  vessel  in  which  it  is  to  remain.  This  will 
kill  all  living  bacteria,  but  will  not  destroy  spores.  Hence 
to  render  milk  absolutely  sterile,  repetition  of  the  process  on 
successive  days  is  necessary.    This  is  rarely  done,  as  the 


MILK  AND  MILK  PRODUCTS 


189 


spores  are  not  likely  to  develop  if  the  milk  is  kept  at  a 
temperature  of  40°  F.  or  less. 

Sterilized  milk  is  not  an  ideal  food.  Boiling  changes  the 
taste,  the  cream  does  not  rise  as  quickly,  and  it  is  less  easily 
coagulated  by  the  action  of  rennet.  Lecithin  is  decomposed, 
diminishing  the  amount  of  organic  phosphorus  compounds^ 
and  increasing  the  inorganic  phosphorus  which  is  not  as  use- 
ful to  the  body.  The  calcium  salts  are  changed,  and  the 
ferments  of  the  milk  destroyed.  Sterilization  should  be  re- 
garded as  an  emergency  measure,  for  hot  weather,  when  cool- 
ing facilities  are  lacking. 

MILK  PRODUCTS 

Butter.  Butter  consists  almost  entirely  of  separated  milk 
fat.  Churning  causes  the  fat  globules  to  unite  into  a  solid 
mass.  The  cream  is  first  allowed  to  ripen  for  some  hours. 
This  process  gives  the  characteristic  taste  and  odor,  which  is 
due  to  action  of  bacteria.  When  kept,  butter  tends  to  turn 
rancid,  owing  to  the  fermentation  of  a  small  quantity  of  casein 
present.  Salt  is  added  largely  to  prevent  this  change.  But- 
ter is  very  palatable,  and  one  of  the  most  digestible  forms 
of  fat. 

Cheese.  Cheese  is  made  from  full  milk,  skim  milk  or 
cream.  It  consists  of  the  casein  of  the  milk  and  more  or 
less  of  the  fat  and  mineral  matters.  The  flavor  is  due  to  the 
action  of  enzymes  in  molds  or  bacteria.  Cheese  is  a  very 
concentrated  nutritious  food,  and  very  thoroughly  assimilated. 
It  is  not  usually  well  borne  by  invalids  and  convalescents, 
however. 

Cream.  Cream  is  the  fatty  layer  which  forms  at  the  top 
of  milk  which  is  allowed  to  stand  undisturbed.  It  contains 
the  fat  of  the  milk,  water,  some  protein,  carbohydrates  and 
mineral  matter.  The  percentage  of  fat  is  exceedingly  vari- 
able, ranging  from  about  16  per  cent,  to  40  per  cent.  The 
cream  which  rises  on  milk  after  24  hours  is  called  gravity 
cream  and  contains  about  16  per  cent.  fat.  The  richer  creams 
are  obtained  by  centrifugalizing  the  milk.    Cream  in  large 


190 


ANIMAL  FOODS 


quantities  is  less  easily  digested  than  an  equal  amount  of 
whole  milk  because  of  the  large  amount  of  fat^  but  this  form 
of  fat  is  easily  digested  compared  with  other  food  fats^  and 
hence  is  often  ordered  by  physicians. 

Curds.  When  milk  sours^  owing  to  the  formation  of 
lactic  acid  by  the  action  of  lactic  acid  bacteria  upon  the 
sugar^  or  when  the  enzyme  rennet  is  added  to  fresh  milk  at 
body  temperature^  and  the  clot  is  stirred^  the  curds  separate 
from  the  whey. 

Curds  consist  of  coagulated  casein^  which  commonly  car- 
ries with  it  the  fat;  gentle  heat  facilities  this  separation^  but 
a  high  temperature  renders  the  curd  tough  and  indigestible; 
with  or  without  the  addition  of  cream^  curds  are  used  as 
cottage  cheese.    It  is  a  very  cheap^  nutritious  food. 

Jun'ket.  If  sweet  milk  is  allowed  to  stand  undisturbed 
after  the  addition  of  rennet,  the  thickened,  custard-like  mass 
is  called  junket.  This  is  a  valuable  method  of  using  milk, 
especially  for  invalids,  children,  and  those  who  from  personal 
idiosyncrasy  cannot  drink  milk. 

Whey,  This  substance  may  be  either  sweet  when  formed 
by  junket  or  sour  when  otherwise  produced.  It  contains 
most  of  the  lactose,  lactalbumin  and  ash  constituents  of  the 
milk,  but  has  so  little  nutritive  value,  owing  to  the  removal  of 
the  milk  fat  and  casein,  that  it  may  be  regarded  as  a  beverage. 
See  page  185. 

Sour  MilJc,  When  whole  milk  sours,  with  the  formation 
of  curds  and  whey,^^  the  entire  product  is  known  as  clabber 
or  bonny-clabber.  It  is  wholesome,  and  nutritious,  since  it 
contains  all  the  ingredients  naturally  present  in  milk.  By 
some  it  is  used  as  a  beverage.  When  not  so  relished,  it  can  be 
used  to  good  advantage  in  cooking,  adding  its  nutritive  value 
to  any  dish  in  which  it  is  incorporated. 

Buttermilh,  True  buttermilk,  which  is  common  on  farms, 
is  seldom  found  in  commerce.  Unless  produced  where  sold, 
its  genuineness  may  be  a  matter  of  question.  Those  who  are 
familiar  with  the  genuine  article  state  that  the  delicacy  of 
its  flavor,  its  consistency,  etc.,  are  much  superior  to  the  so- 


MILK  AND  MILK  PRODUCTS  191 


called  buttermilk  of  commerce.  The  composition  of  the  two 
articles  is  practically  the  same.  When  skim  milk,  the  cream 
having  been  removed  by  the  separator,  is  allowed  to  sour,  it 
is  said  to  resemble  ordinary  buttermilk,  and  the  fluid  which 
goes  by  the  latter  name,  sold  extensively  throughout  Greater 
Xew  York,  is  said  to  be  sour  skim  milk. 

Metschnichoff  Artificially  Soured  Milk,  The  announce- 
ment some  years  ago  by  Metschnickoff  that  the  foregoing 
products  were  of  very  great  hygienic  and  therapeutic  value  in 
disinfecting  the  intestines  has  resulted  in  the  wholesale  pro- 
duction of  a  substance  which  differs  from  ordinary  sour 
milk  in  that  it  is  prepared  from  a  pure  culture  of  lactic- 
acid  germs.  This  product  is  doubtless  destined  to  replace 
the  older  ones  on  account  of  its  freedom  from  undesirable 
forms  of  bacteria.  The  technique  for  preparing  it,  devised 
originally  by  Metschnickoff  himself,  also  places  it  in  a  higher 
class  than  the  older  preparations.  The  pure  culture  is  sold 
in  the  solid  form  as  Buttermilk  Tablets. 

Fermented  Milk.  Milk  which  has  been  fermented  is  really 
a  derivative  of  native  milk,  and  in  parts  of  Europe  and  Asia 
constitutes  an  important  article  of  diet.  The  fermentation 
is  either  the  lactic  alone  or  lactic  and  alcoholic  together. 

The  ferments  used  consist  chiefly  of  various  "  leavens 
or  cultures  which  cause  lactic  acid  fermentation.  People  who 
have  subsisted  on  this  milk  for  centuries  simply  use  a  por- 
tion of  old  fermented  milk  to  leaven  fresh  milk.  These 
leavens  vary  considerably  in  composition,  and  the  milk  used 
may  be  from  one  of  several  domestic  animals.  Some  leavens 
contain  yeast  germs,  as  that  alcohol  may  or  may  not  be 
present.  The  native  preparations  which  have  been  imitated 
in  this  country  are  kumyss,  kefir  and  matzoon. 

Kumyss  was  prepared  originally  from  mares'  milk.  The 
leaven  contains  lactic  acid  germs  and  yeast.  The  product 
therefore  contains  lactic  acid,  alcohol,  and  carbonic  acid 
gas,  representing  an  acid,  effervescing,  mildly  alcoholic  bev- 
erage. The  casein  curd  is  finely  broken  up  and  partially 
digested.    Kumyss  has  been  imitated  in  America  by  adding 


192 


ANIMAL  FOODS 


yeast  to  milk  and  allowing  fermentation  to  proceed  twenty- 
four  hours  or  over. 

Kefir  was  made  originally  from  cows'  milk  with  a  leaven 
of  kumyss.  This  has  been  sold  in  tablet  form  like  the  ren- 
net ferment.  Kefir  resembles  kumyss  so  closely  that  no 
further  description  is  necessary. 

Matzoon  differs  from  the  preceding  chiefly  in  containing 
no  alcohol. 

Modified  MilJc  is  milk  containing  definite  proportions  of 
fat,  sugar,  proteids,  etc.,  put  up  usually  according  to  the 
formula  of  a  physician,  who  prescribes  the  quantity  of  the 
different  constituents  he  desires. 

For  sick  children  and  in  convalescence  it  is  of  great  value 
to  obtain  a  modification  in  which  the  composition  is  definite 
and  accurate.  It  can  then  be  known  what  mixtures  will  agree 
with  the  patient. 

Malted  Milk  is  a  pure  food  prepared  from  rich  full-cream 
milk,  combined  with  the  valuable  nutritive  extracts  of  malted 
barley  and  wheat.  This  product  being  highly  concentrated 
and  partially  predigested,  supplies  a  large  amount  of  nutrition 
with  little  tax  upon  the  digestive  organs.  It  is  a  valuable 
nutrient  in  dyspepsia  or  impaired  digestion,  for  fever  and 
wasting  diseases,  the  convalescent,  nursing  mothers,  and  the 
aged. 

Peptonised  MilJc  is  milk  in  which  the  casein  or  curd  has 
been  made  soluble  and  diffusible  by  means  of  the  Peptonising 
Tubes.  In  these  Peptonising  Tubes,  extractum  pancreatis, 
containing  the  pancreatic  ferment  which  acts  especially  upon 
the  proteins  of  milk,  is  combined  with  soda  bicarbonate  in 
due  proportion,  and  each  tube  contains  sufficient  peptonising 
powder  to  peptonise  a  pint  of  milk.  Milk  may  be  peptonised 
by  various  methods  —  by  the  "  cold  process,^'  "  immediate 
process,'^  warm  process,^'  etc.  The  method  and  degree  of 
peptonisation  suitable  for  any  special  case  is  soon  determined 
by  experience,  by  the  agreeability  of  the  milk  and  its  digesti- 
bility. 

Condensed  Millc.    Preservation  of  milk  by  condensation 


MILK  AND  MILK  PRODUCTS 


193 


constitutes  a  very  extensive  commercial  industry.  There  are 
several  processes  in  vogue,  and  the  product  is  either  sweet- 
ened or  unsweetened.  Ordinary  unsweetened  milk  contains 
about  12  per  cent,  each  of  protein  and  fat  and  16  per  cent, 
of  the  native  milk  sugar,  making  the  total  solids  40  per  cent. 
Cane  sugar  may  be  added  to  the  amount  of  about  40  per  cent, 
more,  making  the  total  solids  80  per  cent.  Milk  may  also 
be  condensed  by  forcing  filtered  air  through  it,  until  its  vol- 
ume is  reduced  to  one-fourth  the  original  amount.  This 
product  is  sold  in  sterile  bottles.  Condensed  milk  is  very 
generally  used  as  a  substitute  for  fresh  milk.  It  is  especially 
valuable  in  tropical  regions  and  on  ocean  voyages.  It  is 
important  that  condensed  milk  be  made  from  clean  milk,  and 
kept  free  from  bacteria  contamination.  The  unsweetened 
brands  are  especially  liable  to  putrefaction,  and  should  be 
cared  for,  when  opened,  like  fresh  milk. 

Evaporated  Milk  is  made  of  pure  milk,  fresh  from  the 
cow,  nothing  taken  from  it  to  lessen  its  nourishing  qualities 
and  nothing  added.  It  is  sterilized  by  the  application  of  a 
higher  degree  of  heat  than  is  used  in  ordinary  pasteurization. 


Methods  of  Preparing,  Put  bottle  into  kettle  of  cold 
water  and  slowly  bring  to  the  boiling  point.  Boil  ten  minutes. 
After  which  fill  immediately  nearly  full  with  milk ;  cork  with 
absorbent  cotton  which  has  been  baked  in  the  oven  until  a 
^delicate  brown.  Place  bottles  on  a  rest  in  a  deep  pan  so  that 
they  will  not  touch  bottom,  and  fill  the  pan  with  cold  water  to 
reach  as  high  as  the  milk  in  bottles.  Heat  water  gradually  to 
155  to  167  degrees  Fahrenheit,  or  until  small  bubbles  appear 
in  the  milk  next  to  the  glass.  Eemove  to  back  of  stove  and 
keep  milk  at  same  temperature  20  to  45  minutes;  then  cool 


ENERGY  VALUE  OF  MILK 


1  cup  of  whale  milk 
1  cup  skimmed  milk 
1  cup  cream  (18%) 
1  cup  cream  (40%) 


=  169  Calories. 
=  89  Calories. 
=  440  Calories. 
=  864  Calories. 


PASTEURIZATION 


194 


ANIMAL  FOODS 


quickly  to  45  degrees  or  lower.  To  cool  rapidly  put  bottles 
first  into  lukewarm  water  and  then  cold  water  until  milk  is 
cold^  then  surround  with  ice  water.  Keep  in  cold  place  and 
do  not  remove  stoppers  until  ready  to  use.  Note  Pasteuriza- 
tion^ page  188. 

Utensils,  A  convenient  form  of  apparatus  for  pasteuriza- 
tion is  known  as  the  Hygeia  Pasteurizer  or  Sterilizer.  Or 
a  covered  tin  pail  answers  well  for  the  larger  vessel^  and  an 
inverted  pie  pan  with  perforated  bottom  can  serve  as  the 
false  bottom.  A  hole  may- be  punched  in  the  cover  of  the 
pail^  a  cork  inserted  and  a  chemical  thermometer  put  through 
the  cork  so  that  the  bulb  dips  in  the  water^  thus  enabling  one 
to  watch  the  temperature  closely  without  removing  the  cover, 
or  an  ordinary  dairy  thermometer  may  be  used  from  time 
to  time  by  removing  the  lid. 

STERILIZATION 

The  utensils  and  methods  to  sterilize  milk  are  the  same  as 
for  pasteurizing,  except  that  the  water  is  heated  to  the  boil- 
ing point  (212°  r.)  and  the  time  for  boiling  is  ten  or  more 
minutes.    Note  Sterilization,  page  188. 

EVAPORATED  MILK 

It  is  sometimes  of  advantage,  as  in  cases  of  dilated  stom- 
ach or  whenever  the  total  amount  of  fluids  must  be  cut  down 
to  a  given  point,  to  heat  the  milk  in  a  pan  over  which  is 
placed  an  inverted  funnel.  Much  of  the  water  of  the  milk 
passes  off  as  vapor,  while  the  solids  remain  in  the  pan. 

BAKED  MILK 

Into  a  stone  jar  put  one-half  gallon  of  sweet  milk;  cover 
with  writing  paper  and  tie  it  on.  Bake  in  moderate  oven 
nine  to  ten  hours.    It  will  be  the  consistency  of  thick  cream. 

MALTED  MILK,  59  CALORIES 

Mix  one  tablespoon  of  Horlick's  Malted  Milk  powder  with 
a  little  tepid  water  to  make  a  smooth  paste ;  add  three-fourths 
cup  water,  hot  or  cold,  stirring  briskly  and  serve. 


MILK  AND  MILK  PRODUCTS  195 


Xote. —  May  be  prepared  with  hot  milk  instead  of  water 
and  a  little  cream  added  if  desired. 

PEPTONISED  MILK,  338  CALORIES 
Warm  Process 

Put  one-half  cup  (gill)  of  cold  water  and  the  powder  con- 
tained in  one  of  the  Peptonising  Tubes  (Fairchild)  into  a 
clean  quart  bottle  and  shake  thoroughly;  add  a  pint  of  cold 
fresh  milk  and  shake  again;  then  place  the  bottle  in  a  pail 
or  kettle  of  warm  water  —  about  115°  F.^  or  not  too  hot  to 
immerse  the  whole  hand  in  it  without  discomfort.  Keep 
the  bottle  in  the  water  bath  for  five  or  ten  minutes,  or  longer 
if  it  is  desired  to  peptonise  the  milk  quite  completely,  then 
put  it  immediately  on  ice  —  directly  in  contact  with  the  ice 
—  in  order  to  check  the  process  of  digestion  and  keep  the  milk 
from  spoiling. 

The  degree  of  peptonisation  is  very  simply  regulated  in 
this  process  by  the  length  of  time  during  which  the  milk  is 
kept  in  the  water  bath.  It  is  seldom  necessary  to  peptonise 
milk  until  it  becomes  bitter. 

PARTIALLY  PEPTONISED  MILK,  338  CALORIES 

Put  one-half  cup  (gill)  of  cold  water  and  the  powder  con- 
tained in  one  of  the  Peptonising  Tubes  (Fairchild)  into  a 
clean  saucepan,  and  stir  well;  add  a  pint  of  cold  fresh  milk, 
and  heat,  with  constant  stirring,  to  boiling  point.  The  heat 
should  be  so  applied  that  the  milk  will  come  to  a  boil  in  ten 
minutes.  Let  it  cool  to  about  lukewarm,  then  strain  into  a 
clean  bottle  or  glass  jar,  cork  tightly  and  keep  in  a  cold 
place.  The  bottle  or  jar  should  always  be  well  shaken  before 
and  after  pouring  out  a  portion.  The  milk  may  be  taken 
cold  or  hot  as  the  physician  may  direct. 

Partially  peptonised  milk  "  if  properly  prepared  will  not 
become  bitter. 

PEPTONISED  MILK,  338  CALORIES 
Cold  Process 

Put  one-half  cup  (gill)  of  cold  water  into  a  clean  quart 
bottle  and  dissolve  in  it  by  shaking  thoroughly  the  powder 


196 


ANIMAL  FOODS 


contained  in  one  of  the  Peptonising  Tubes  (Fairchild) ;  add 
a  pint  of  cold  fresh  milk,  shake  the  bottle  again,  and  im- 
mediately place  it  on  ice  —  directly  in  contact  with  the  ice. 

The  bottle  should  always  be  well  shaken  before  and  after 
pouring  out  a  portion. 

Peptonised  milJc  prepared  by  this  recipe  is  especially  ap' 
predated  by  patients  who  dislike  the  taste  of  warmed  or 
boiled  milk,  and  ordinarily  it  is  readily  digested  and  assimi- 
lated, 

PEPTONISED  MILK 
Immediate  Process 

Put  two  tablespoons  (1  oz.)  of  cold  water  into  a  goblet 
or  glass;  dissolve  in  this  one-quarter  of  the  contents  of  a 
Peptonising  Tube  (Fairchild)  ;  add  eight  tablespoonfuls 
(4  ozs.)  of  warm  milk  —  not  boiling;  drink  immediately, 
sipping  slowly;  85  calories. 

To  prepare  half  a  pint  of  milk,  use  half  the  contents  of  a 

Peptonising  Tube,  4  tablespoonfuls  of  water,  a  half  pint  of 

milk;  169  calories. 

SPECIALLY  PEPTONISED  MILK,  338  CALORIES 

For  Making  Milk  Jelly,  Milk  Punch,  Milk  Lemonade,  and  for  Use 
with  Fruit  Juices  or  Acids 

Peptonise  a  pint  of  milk  by  the  ^^Warm  Process,'^  keep- 
ing the  bottle  in  the  water  bath  for  one  hour;  pour  the  pep- 
tonised milk  into  a  saucepan  and  heat  to  boiling,  when  it  is 
ready  for  use  if  it  is  required  hot ;  or  it  may  be  put  on  ice,  in 
a  bottle  or  any  suitable  container,  to  be  used  for  punches, 
lemonade,  etc. 

It  is  necessary  to  peptonise  the  milk  quite  completely  — 
for  one  hour  —  so  that  it  will  not  curdle  when  mixed  with 
lemon  juice  or  acid.  The  bitter  taste  of  this  "  specially 
peptonised  milk^^  is  not  evident  in  the  jellies,  punches,  etc., 
and  these  foods  are  very  agreeable  and  exceedingly  assimil- 
able. 

EFFERVESCENT  PEPTONISED  MILK 

Into  a  glass  put  some  finely  cracked  ice  and  fill  it  half- 
full  of  vichy,  Apollinaris  or  siphon  water,  add  immediately 


MILK  AND  MILK  PRODUCTS 


197 


peptonised  milk  prepared  by  any  of  the  prescribed  methods 
and  drink  while  effervescing.  Brandy  or  other  spirits  may  be 
added  if  desired. 

THICKENED  MILK 

See  Flour  Gruel.    Page  239. 

EICE  MILK,  458  CALORIES 

1  ounce  rice.  1  saltspoon  salt. 

1  pint  scalded  milk.  1  teaspoon  sugar. 

Soak  rice  twelve  hours^  strain  and  add  the  scalded  milk, 
salt  and  sugar.  Stir  well  and  cook  slowly  one  hour.  Eub 
through  a  fine  sieve  (thin  with  more  hot  milk  if  desired). 
Taste  and  add  more  seasoning  if  necessary.  Sago  or  tapioca 
may  be  used  in  the  same  way. 

RUM  AND  MILK,  186  CALORIES 

34  cup  milk.  1%  teaspoon  sugar. 

%  tablespoon  rum  or  brandy. 

Use  fresh  or  pasteurized  milk.    Put  ingredients  into  a 

lemonade  shaker  or  fruit  jar  (using  rubber  band  and  cover)  ; 

cover  well  and  shake  until  frothy.  Serve  in  glass  three- 
fourths  filled. 

SHERRY  OR  BRANDY  AND  MILK,  173  CALORIES 

%  cup  fresh  milk.  %  teaspoon  sugar. 

%  tablespoon  brandy  or  Nutmeg. 
1/3  wineglass  of  sherry. 

Blend  as  for  "  Eum  and  Milk.^^  Fill  glass  three-fourths 
full  and  add  a  grating  of  nutmeg  on  top. 

CINNAMON  AND  MILK,  132  CALORIES  1 
%  cup  new  milk.  Sugar. 
Stick  cinnamon.  1/3  teaspoon  brandy. 

Boil  milk,  with  sufficient  cinnamon  to  flavor  pleasantly, 
and  sweeten.  This  may  be  taken  cold  with  the  brandy. 
Very  good  in  cases  of  diarrhoea.  Children  may  take  it  warm 
without  brandy. 

1  Without  sugar. 


198 


ANIMAL  FOODS 


WHEY 

6l^  ounces  whey  =  50  Calories. 
1  cup  fresh  milk.  1  teaspoon  cold  water. 

14  Hansen's  Junket  Tablet. 

Heat  the  milk  until  lukewarm;  add  the  tablet,  dissolved 
in  the  cold  water.  Allow  it  to  jelly  in  a  warm  place.  Then 
break  up  the  curd  and  strain  through  two  thicknesses  of 
cheese-cloth,  being  careful  to  remove  all  the  casein.  Serve 
cold,  with  or  without  sweetening,  and  flavor  as  desired. 

LIQUID  PEPTONOIDS  AND  WHEY 

Place  one  tablespoonful  of  finely  cracked  ice  in  a  small  tea- 
cup. Pour  over  it  one  tablespoonful  of  Liquid  Peptonoids; 
stir,  fill  the  cup  with  whey  and  drink  slowly. 

ACID  PHOSPHATE  WHEY 

See  "  Acid  Beverages    for  recipe.    Page  113. 

LEMON  WHEY 

See  "Acid  Beverages    for  recipe.    Page  113. 

WINE  WHEY 

See  "  Acid  Beverages    for  recipe.    Page  113. 

PANOPEPTON  WITH  WHEY 

Put  into  a  small  teacup  one  or  two  teaspoonfuls  of  clean 
crushed  ice ;  add  one  tablespoonful  of  Panopepton,  stir,  then 
fill  the  cup  with  whey.  Drink  slowly.  This  is  very  refresh- 
ing and  nourishing  —  an  admirable  liquid  food  for  fever 
patients  and  convalescents. 

KTTMYSS,  328  CALORIES 

J  cake  Fleischmann's  yeast.  1  tablespoon  water. 

ll^  tablespoons  sugar.  1  quart  milk. 

Make  a  thin  syrup  of  the  sugar  and  water  and  cook  one 
minute.  Soften  the  yeast  in  two  tablespoons  of  lukewarm 
milk.  Heat  the  milk  until  lukewarm,  add  other  ingredients 
and  shake.  Put  in  sterile  patent  beer  bottles,  place  in  up- 
right position  for  twelve  hours,  at  70  degrees  Fahrenheit 
(or  comfortably  warm  room) ;  then  turn  on  side  at  heat 


MILE  AND  MILK  PRODUCTS 


199 


50  degrees  Fahrenheit  (lower  part  of  ice-box).  Eeady  for 
use  after  the  first  twenty-four  hours ;  often  kept  several  days, 
but  the  longer  it  is  kept  the  less  palatable  it  is.  Do  not 
open  a  bottle  of  kumyss  without  a  champagne  tap^  or  the 
cork  may  be  punctured  with  a  stout  needle  to  let  the  gas 
escape.    It  should  look  like  thick^  foamy  cream. 

Kumyss  is  especially  suited  for  many  forms  of  indigestion, 
nausea,  fever  and  gastric  trouble,  pulmonary  consumption  and 
other  wasting  disease. 

Dr.  Brushes  prepared  kumyss  is  recommended  on  account 
of  its  superiority  over  the  home-made  preparations,  as  the 
milk  supply  is  controlled^  and  the  method  of  preparing  is 
carried  out  upon  scientific  bases.  It  is  also  more  convenient, 
as  it  is  ready  for  immediate  use. 

MATZOON  OR  ZOOLAK  (GERMAN  HOSPITAL,  NEW  YORK  CITY) 
1  pint  =  338  Calories. 

Take  forty-five  pints  of  milk,  boil  thoroughly.  Cream 
two  or  three  times;  that  is,  until  all  the  cream  is  removed. 
When  the  milk  is  still  quite  warm  add  two  (2)  bottles  of 
prepared  bottled  Zoolak.  Mix  thoroughly.  Bottle  quickly  in 
pint  bottles,  not  entirely  full.  Cork  tightly  immediately,  and 
put  in  a  warm  place  till  the  liquid  shows  creamy  through  the 
bottles.    Then  place  and  keep  in  a  cold  place. 

N.  B. —  If  chilled  before  it  is  thick  it  remains  thin  and 
the  flavor  is  spoiled.  If  not  kept  very  cold  after  it  is  made 
the  fermentation  is  carried  too  far. 

JUNKET,  169  CALORIES 

1  cup  fresh  milk.  1  teaspoon  cold  water. 

14  Hansen's  Junket  Tablet. 

Heat  the  milk  until  lukewarm;  add  the  tablet  dissolved 
in  the  cold  water;  allow  it  to  jelly  in  a  warm  place;  chill  in 
ice-box;  serve  plain  or  in  the  various  ways  as  directed  in 
chapter  "  Nutritious  Desserts.'' 

ARTIFICIAL  OR  HOMEMADE  BUTTERMILK 

1  cup  (whole  milk  buttermilk)  =169  Calories. 
Pasteurize  fresh,  sweet  milk,  which  may  be  new,  or  partly 


200 


ANIMAL  FOODS 


skimmed^  or  entirely  fat-free^  as  desired,  by  heating  it  to 
between  160  and  175  degrees  F,  and  holding  at  such  tem- 
perature for  at  least  20  minutes,  cool  to  100  degrees. 

Dissolve  one  Junket  Brand  Buttermilk  Tablet  in  a  table- 
spoon of  cold  milk  or  water  and  add  a  quart  or  less  of  the 
pasteurized  milk.  Leave  in  warm  room  until  thick,  24:  to 
36  hours. 

When  milk  has  thickened,  place  in  refrigerator.  When 
cold,  "  Churn  by  shaking  the  bottle  vigorously  for  a  minute 
or  two.  Or  the  milk  may  be  prepared  in  a  fruit  jar,  a  bowl 
or  a  pitcher  and  beaten  with  an  egg  beater  until  smooth  and 
creamy. 

If  the  acid  flavor  is  too  mild,  let  stand  cold  another  day. 

If  desired,  the  milk  may  be  diluted  with  one-fourth  water. 
A  pinch  of  salt  may  be  added. 

Junket  Buttermilk  may  be  kept  on  ice  or  in  refrigerator 
for  a  week  or  longer. 

SWEETBREADS 

Among  epicures  sweetbreads  are  considered  a  dainty  and 
are  certainly  a  most  acceptable  food  for  the  sick,  as  they  are 
easily  digested,  but  they  must  not  be  used  to  excess  on  account 
of  the  large  amount  of  uric  acid  which  they  produce. 

Definition.  Sweetbreads  are  the  pancreas  and  thymus 
glands  of  the  calf,  the  word  being  used  for  either  one  or 
both  organs.  The  thymus  glands  are  removed  and  used  for 
food  while  the  animal  lives  on  milk.  The  pancreas  of  the 
calf  is  sometimes  called  stomach  sweetbread,  and  the  thymus 
gland  the  neck  or  throat  sweetbread.  The  latter  is  con- 
sidered somewhat  more  easily  digested  than  the  former. 

Digestibility.  It  is  an  error  to  state  that  sweetbreads  are 
more  digestible  because  they  contain  digestive  ferments  in 
life,  for  these  are  destroyed  by  cooking.  The  tenderness  of 
these  bodies  is  due  doubtless  to  the  delicate  character  of  the 
connective  tissue,  and  to  the  soft  character  of  the  gland  tis- 
sue itself,  which  is  rich  in  nucleo-protein.    The  presence  of 


SWEETBREADS 


201 


this  nuclein  is  objectionable  for  gouty  and  other  patients 
with  uric  acid  disorders^  but  this  is  no  contraindication  for 
an  occasional  use  of  them  by  invalids. 

ENERGY  VALUE  OF  SWEETBREADS 

100  grams  (314  oz.)   sweetbreads  =176  Calories. 

1  pair  sweetbreads,  raedium  size  ( 8  oz. )  .  .  =;  399  Calories. 
1  pair  sweetbreads,  medium  size  (8  oz. ),  w^lien  cooked,  freed  from 
membrane,  pipe,  etc.,  and  cut  into  cubes,  measures  three- fourths 
cup. 

TO  PREPARE  SWEETBREADS 
(To  Parboil.) 

Eemove  from  paper  as  soon  as  received  from  market,  plunge 
into  cold  water  and  allow  to  stand  one  hour.  Drain.  Place 
immediately  in  boiling  water  salted  water  to  cover^  allowing 
one-half  tablespoon  each  of  salt  and  vinegar  to  a  pair  of 
sweetbreads.  Simmer  twenty  minutes;  again  drain  and 
plunge  into  cold  water  that  they  may  keep  white  and  firm. 
Free  from  membrane  fat  and  veins,  and  serve  as  desired. 

Sweetbreads  are  always  prepared  in  this  way  for  subse- 
quent cooking  and  are  spoken  of  as  parboiled. 

BROILED  SWEETBREADS 

Parboil  and  cut  in  halves  cross-wise.  Sprinkle  with  salt 
and  pepper,  place  on  a  greased  fine  wire  broiler,  and  broil 
five  minutes  over  a  clear  fire.  As  soon  as  sweetbread  is 
heated  brush  both  sides  with  a  little  melted  butter.  Serve 
with  creamed  butter  to  which  has  been  added  a  little  lemon 
juice  or  simply  spread  with  soft  butter. 

CREAMED  SWEETBREADS  NO.  I,  288  CALORIES 

(Individual  Rule.) 
l^  tablespoon  butter.  i/i  cup  milk. 

tablespoon  flour.  1/3  cup  sweetbreads. 

Melt  the  butter,  add  flour  and  pour  on  gradually  the  scald- 
ing milk.  Cook  thoroughly  and  season.  Add  the  parboiled 
sweetbreads  cut  in  small  pieces,  reheat  and  serve  on  toast  and 
garnish  with  parsley. 


203 


ANIMAL  FOODS 


Xote. —  For  Scalloped  Sweetbreads  put  creamed  sweetbreads 
in  small  baking  dish ;  cover  with  cracker  crumbs  and  dot  with 
bits  of  butter;  bake  until  crumbs  are  a  golden  brown. 

CREAMED  SWEETBREADS  NO.  II,  968  CALORIES 

(Three  Servings.) 

1  cup  thin  cream  or  rich  milk.      %  teaspoon  salt. 

2  teaspoons  butter.  %  cup  sweetbreads. 
2  tablespoons  flour. 

Parboil  sweetbreads  and  cut  into  one-half  inch  cubes. 
Blend  flour  with  a  little  cold  milk  to  make  a  smooth  mixture ; 
scald  cream  in  double  boiler^  add  the  flour  mixture  and  cook 
thoroughly.  Just  before  serving  add  the  prepared  sweet- 
breads^ salt  and  butter.  Serve  hot  on  toasted  rounds,  and 
garnish  with  parsley,  or  use  as  a  filling  for  Swedish  tim- 
bales. 

Note. —  May  use  equal  proportions  of  cold  cooked  chicken 
and  sweetbreads,  reheat  and  serve  in  the  cream  sauce. 

FRICASSEED  SWEETBREADS,  240  CALORIES  i 

(Three  Servings.) 
Parboil  and  cut  sweetbread  into  one-half  inch  pieces. 
Make  a  sauce  using: 

2  teaspoons  butter.  %  cup  hot  strong  chicken  broth. 

1  teaspoon  flour.  l^  cup  cream. 

%  teaspoon  lemon  juice.  Salt  and  pepper. 

Melt  the  butter,  add  the  flour,  allow  it  to  simmer  until 
a  golden  brown,  then  add  the  hot  broth  gradually,  stirring 
constantly,  lastly  the  cream.  Season  with  salt,  pepper  and 
lemon  juice.  A  speck  of  curry  powder  may  be  added  if 
desired. 

Put  the  cut  sweetbread  into  the  sauce,  simmer  flve  minutes 
and  serve  on  sippets  or  squares  of  dry  toast;  garnish  with 
parsley. 

SWEETBREADS  WITH  PEAS 

1  cup  of  canned  peas  =  100  Calories. 
Parboil  and  broil  sweetbreads,  arrange  in  center  of  plat- 
ter, and  serve  the  peas  (cooked  and  seasoned)  around  them. 

1  Calculated  without  the  sweetbreads. 


GELATIN 


203 


Or  the  peas  may  be  piled  in  center  of  platter  and  the  broiled 
sweetbreads  arranged  as  a  border.  A  cream  sauce  may  be 
poured  over  all;  for  it^  use  the  recipe  in  Creamed  Sweet- 
breads Xo.  I  or  II. 

GELATIN 

Source.  Gelatin  is  a  nitrogenous  food  classed  with  pro- 
teins, under  the  division  called  gelatinoids  or  albuminoids,  and 
derived  from  "  collagen/^  the  chief  constituent  of  connective 
tissue  with  its  various  modifications,  as  tendons,  "  chondri- 
gen  of  cartilage,  or  the  ossein  of  bone.  "  By  proper 
treatment,  any  form  of  connective  tissue  can  be  made  to  yield 
gelatin.  Hide  clippings  yield  glue,  a  crude  form  of  gelatin, 
and  much  commercial  gelatin  is  simply  a  purified  glue,  derived 
from  such  a  source.  Isinglass,  obtained  from  the  swimming 
bladder  of  the  sturgeon  and  other  fish,  is  the  purest  form  of 
gelatin;  the  gelatin  obtained  from  calves'  feet  is  also  of  high 
quality.^'  ^ 

General  Principles  in  CooJcing,  Gelatin  is  insoluble  in 
cold  water,  but  when  allowed  to  stand  in  it  will  swell  from 
absorption  of  water.  Gelatin  is  very  soluble  in  boiling 
water,  and  on  cooling  sets  into  a  jelly.  This  jellying  will 
occur  in  a  solution  containing  as  little  as  1  per  cent,  of 
gelatin.^'  ^  Gelatin  is  decomposed  by  boiling  and  conse- 
quently if  allowed  to  boil  will  not  solidify  on  cooling. 

Digestibility.  Gelatin  is  very  easily  digested  in  the  stom- 
ach, and  readily  absorbed  from  the  small  intestines. 

Nutritive  Value.  Although  gelatin  is  a  protein  food,  it 
cannot  alone  support  life.  Proteins  are  made  up  of  groups 
of  amino  acids,  most  of  which  it  seems  necessary  to  have 
represented  in  the  diet,  to  secure  complete  repair  of  the  waste 
of  nitrogenous  tissue.  In  gelatin  two  important  acids  are 
lacking ;  hence  not  more  than  two-thirds  of  the  day's  nitrogen 
requirement  should  be  given  in  the  form  of  gelatin.  Because 

^  state  of  Connecticut.  Report  of  The  Connecticut  Agricultural  Experi- 
ment Station.  Food  and  Drug  Products,  1909.  Being  Part  II  of  the 
Biennial  Report  of  1909-1910. 


204 


ANIMAL  FOODS 


it  can  to  this  extent  take  the  place  of  other  proteins^  gelatin 
has  often  been  called  a  "protein-sparer/^  rather  than  a  true 
protein.  In  the  ordinary  intake  of  animal  food,  not  more 
than  one-eighth  of  the  total  nitrogen  is  in  the  form  of  gelatin.. 
It  is  usually  not  convenient  to  take  more  than  25  to  30 
grams  (about  1  ounce)  in  a  day.  Six  ounces  of  calf's  foot 
jelly  (which  would  be  a  large  helping)  contain  less  than  half 
an  ounce  of  gelatin.  Jellying  will  occur  in  a  solution  con- 
taining as  little  as  1  per  cent,  of  gelatin.  Gelatin  has  the 
advantage  (along  with  othei"  proteins)  of  fixing  a  good  deal 
of  acid  in  the  process  of  stomach  digestion  and  is  thus  of 
service  in  cases  of  hyperacidity  of  the  stomach,  when  given 
in  other  forms  than  acid  jellies.  It  seems  also  to  promote 
the  secretion  of  gastric  juice.  It  is  useful  in  febrile  states 
as  it  really  belongs  with  liquid  foods,  melting  as  it  does  at 
body  temperature. 

In  convalescence,  acid  jellies  (orange,  lemon,  etc.,)  are  of 
service  as  a  pleasant  supplement  to  the  ordinary  diet,  but  the 
actual  nutriment  which  they  supply  is  small. 

Extra  nutriment  can  be  added  to  gelatin  by  combining  it 
with  eggs  and  milk,  as  in  Snow  Pudding,  Charlottes  of 
various  kinds,  Spanish  Cream,  etc.,  all  of  which  are  attrac- 
tive forms  of  invalid  diet. 

Meat  J ellies  are  condensed  form  of  broth,  and  are  prepared 
by  taking  any  meat  containing  a  large  proportion  of  connec- 
tive tissues  and  cooking  long  and  slowly.  (Note  broths,  page 
217  for  directions  and  recipes.)  Home-made  jellies,  prop- 
erly prepared,  have  a  pleasing  flavor  and  are  an  agreeable 
addition  to  diet  of  an  invalid,  although  their  nutritive  value 
is  low. 

WINE  JELLY  NO.  I,  165  CALORIES 

(Individual  Rule.) 
1  teaspoon  granulated  gelatin.      2  tablespoons  wine. 

1  tablespoon  cold  water.  1  tablespoon  orange  juice. 
%  cup  boiling  water.                    1  teaspoon  lemon  juice. 

2  tablespoons  sugar. 


GELATIN 


205 


Soak  gelatin  in  the  cold  water  5  minutes;  add  the  boiling 
water  and  dissolve.  Add  sugar,  wine,  orange  and  lemon 
juice.  When  sugar  is  dissolved,  strain  through  a  cheese- 
cloth into  cold,  wet  molds;  or  chill  in  shallow  soup  plate 
and  when  firm  cut  into  one-half  inch  cubes  and  serve  in 
sherbert  or  champagne  glasses,  or  half  orange  shell  with  a 
little  whipped  cream  on  top. 

WINE  JELLY  NO.  II,  1530  CALORIES 

(Six  Servings.) 
l^  box  shredded  gelatin  or  2  cups  boiling  water. 

2  tablespoons  granulated  gelatin.   1  cup  wine. 
%  cup  cold  water.  Speck  salt. 

ll^  cups  sugar. 

Cover  gelatin  with  the  cold  water  and  let  it  stand  about 
one-half  hour.  Add  the  boiling  water,  sugar  and  salt.  Stir 
till  gelatin  is  dissolved  and  add  the  wine.  Strain  through 
cloth  and  strainer  into  cold,  wet  molds  and  set  in  cold  place 
to  harden.    Serve  plain  or  with  whipped  cream. 

PEPTONOIDS  WINE  JELLY,  192  CALORIES 

14  box  gelatin.  2  tablespoons  sugar. 

4  tablespoons  cold  water.  1  tablespoon  sherry  wine. 

8  tablespoons  boiling  water.  1  tablespoon  Liquid  Peptonoids. 

Soak  gelatin  in  the  cold  water  5  minutes;  add  the  boiling 
ivater,  sugar,  wine  and  Liquid  Peptonoids.  When  sugar  is 
dissolved,  strain  and  pour  into  cold,  wet  molds.  Put  on  ice 
to  harden. 

ORANGE  JELLY  NO.  I,  1020  CALORIES 

(Six  Servings.) 
l^  box  shredded  gelatin  or  1  cup  sugar. 

.   2  tablespoons  granulated  gelatin.   1  cup  orange  juice. 
1/2  cup  cold  water.  Juice  1  lemon. 

2  cups  boiling  water. 

Soak  the  gelatin  in  the  cold  water  one-half  hour;  add  the 
boiling  water  and  dissolve.  Add  sugar  and  fruit  juice, 
strain  through  a  cloth  and  strainer  into  cold,  wet  molds 


306 


ANIMAL  FOODS 


and  set  away  to  harden.  Serve  plain  or  with  whipped 
cream. 

ORANGE  JELLY  NO.  II,  152  CALORIES 

(Individual  Rule.) 
1  teaspoon  granulated  gelatin.      3  tablespoons  orange  juice. 
1  tablespoon  cold  water.  2  teaspoons  lemon  juice. 

1  tablespoon  boiling  water.  2  tablespoons  sugar. 

Make  same  as  preceding.    Soaking  gelatin  five  minutes. 

Cut  orange  in  half^  crosswise^  remove  pulp  with  spoon 
and  strain  through  cheese-cloth.  Fill  halves  with  jelly;  when 
it  is  hardened  cut  with  sharp  knife  into  thirds  (which  leaves 
the  rim  filled  with  jelly).  Serve  three  pieces  on  small  plate 
with  whipped  cream  in  center. 

ORANGE  BASKETS 

Wash  oranges.  Eemove  two  sections  from  the  upper  half 
of  an  orange^  leaving  a  band  of  peel  for  a  handle.  Dig  out 
the  pulp  and  scrape  clean.  Fill  with  lemon  or  orange  jelly, 
cut  into  cubes.    An  attractive  form  to  serve  to  children. 

Note. —  If  these  shells  are  wrapped  in  a  damp  cloth  they 
will  retain  their  shape  for  hours. 

LEMON  JELLY,  142  CALORIES 

(Individual  Rule.) 
1  teaspoon  granulated  gelatin.      2  tablespoons  lemon  juice. 

1  tablespoon  cold  water.  2  tablespoons  sugar. 

14  cup  boiling  water. 

Soak  gelatin  in  the  cold  water  5  minutes;  add  the  boiling 
water^  sugar  and  fruit  juice.  When  the  sugar  is  dissolved, 
pour  into  cold^  wet  molds  and  put  on  ice  to  harden. 

GRAPE  JELLY,  588  CALORIES 

(Individual  Rule.) 
1  tablespoon  granulated  gelatin,  l^  cup  sugar. 

cup  cold  water.  Juice  1  lemon. 

1  cup  boiling  water.  cup  Welch's  grape  juice. 

Soak  gelatin  in  the  cold  water;  add  boiling  water  and 
dissolve.  Add  sugar,  lemon  juice  and  grape  juice;  strain, 
pour  into  cold,  wet  molds  and  cool. 


GELATIN 


207 


This  recipe  may  be  served  in  another  and  very  inviting 
form;  when  the  gelatin  is  firm^  force  it  through  a  potato 
ricer.    Keep  on  ice  until  ready  to  serve. 

PEACH  JELLY,  130  CALORIES 

(Individual  Rule.) 
1  teaspoon  granulated  gelatin.      1  teaspoon  lemon  juice. 
1  teaspoon  cold  water.  1  tablespoon  sherry  wine. 

1  tablespoon  boiling  water.  ll^  tablespoons  sugar. 

3  tablespoons  peach  juice. 

Soak  gelatin  in  the  cold  water  5  minutes;  add  boiling 
water  and  dissolve.  Add  fruit  juice,  wine  and  sugar,  strain 
and  pour  into  a  cold,  wet  mold. 

COFFEE  JELLY,  529  CALORIES 

(Individual  Rule.) 
1  teaspoon  granulated  gelatin.     2  tablespoons  sugar. 

1  tablespoon  cold  water.  7  tablespoons  cream. 

2  tablespoons  strong  hot  coffee. 

Soak  gelatin  in  the  cold  water  5  minutes.  Add  the  hot 
coffee  and  dissolve;  add  sugar  and  strain.  Set  bowl  into 
chopped  ice,  or  ice  water  to  cool,  stirring  occasionally  until 
it  thickens.  Then  add  the  cream,  and  pour  into  cold,  wet 
molds  to  chill. 

PEPTONOIDS  COFFEE  JELLY,  255  CALORIES  i 

box  granulated  gelatin.  Sugar  to  taste. 

4  tablespoons  cold  water.  8  tablespoons  Liquid  Peptonoids. 
8  tablespoons  boiling  coffee. 

Soak  gelatin  in  the  cold  water  5  minutes;  add  the  boiling 
coffee,  sugar  and  Liquid  Peptonoids.  When  sugar  is  dis- 
solved, strain  and  pour  into  cold,  wet  molds.  Put  on  ice 
to  harden. 

CREAM  JELLY,  330  CALORIES 

(Individual  Rule.) 
1  teaspoon  granulated  gelatin.      1  tablespoon  sugar. 
1  tablespoon  cold  water.  Speck  salt. 

3  tablespoons  scalded  milk.  Vanilla  to  taste. 

4  tablespoons  thick  cream. 

^  Without  sugar. 


208 


ANIMAL  FOODS 


Soak  gelatin  in  the  cold  water  5  minutes;  add  the 
scalded  milk  and  dissolve.  Add  the  sugar^,  salt^  cream  and 
vanilla.  Stir  occasionally  until  the  mixture  thickens;  pour 
into  cold^  wet  after-dinner  coflfee  cups^  or  egg  cups^  and  chilL 
Serve  with  Soft  Custard^  or  cream  and  sugar. 

PEPTONISED  MILK  JELLY,  517  CALORIES  i 

(Three  Servings.) 
1  pint  "  specially  peptonised         Rinds  and  juice  of  one  fresh 

milk,"  hot.  lemon  and  orange. 

%  box  gelatin.  '        2  or  3  tablespoons  best  St.  Croix 

Sugar  to  taste.  rum,  or  brandy,  etc. 

Soak  the  gelatin  in  a  cup  of  cold  water^  pour  the  hot  milk 
over  it  and  add  the  sugar;  stir  until  dissolved^  then  throw 
in  the  lemon  and  orange  rinds. 

Squeeze  the  juice  of  the  lemon  and  orange  into  a  glass^ 
and  strain ;  stir  in  the  rum  or  brandy^  etc.^  then  mix  with  the 
milk  and  gelatin;  strain. 

When  the  mixture  has  cooled  to  a  syrup  so  as  to  be  almost 
ready  to  set^  pour  into  molds  or  glasses  wet  in  cold  water 
and  put  on  ice  or  in  cold  water  or  in  a  cold  place  to  harden; 
if  it  is  too  warm  when  poured  into  the  molds,  it  is  apt 
to  separate  in  setting. 

PANOPEPTON  JELLY,  242  CALORIES 

(Three  Servings.) 
1  ounce  fresh  celery  (cut  2  dashes  pepper. 

in  small  pieces ) .  6  tablespoons  Panopepton. 

l^  small  box  best  gelatin.  2  cups  cold  water. 

l^  teaspoon  salt. 

Soak  the  gelatin  in  one-half  cupful  of  cold  water  for  on^ 
hour;  put  the  water  and  celery  in  a  double  boiler  on  the 
fire  and  simmer  one-half  hour;  add  the  salt,  pepper,  and 
soaked  gelatin  and  stir  until  it  is  dissolved;  remove  from 
fire,  add  Panopepton;  stir,  and  strain  through  linen  into  a 
jelly-jar,  and  set  near  ice.    Serve  in  small  quantities. 


^  Without  sugar. 


GELATIN 


209 


PANOPEPTON  JELLY  WITH  ORANGE,  379  CALORIES 

(Three  Servings.) 
%  small  box  best  gelatin.  Juice  and  peel  of  1  orange. 

1  tablespoon  sugar.  1  pint  cold  water. 

6  tablespoons  Panopepton. 

Put  the  gelatin,  orange  peel  (cut  in  small  pieces),  orange 
juice,  and  cold  water  in  a  dish  and  let  it  stand  for  one  hour, 
then  put  in  a  double  boiler  on  the  fire,  add  the  sugar  and  stir 
until  it  is  dissolved ;  now  strain  through  linen,  add  the  Pano- 
pepton and  stir  well.  Pour  into  a  jelly-jar  and  set  near  ice. 
Serve  in  small  quantities. 

MEAT  JELLIES 

See    Meat  Jellies    for  recipe.    Page  221. 

STARCHY  JELLIES 

See    Starchy  Jellies    for  recipe.    Page  244. 

SNOW  PUDDING,  934  CALORIES 

(Six  Servings.) 
%  box  shredded  gelatin  or  1  cup  sugar. 

1  tablespoon  granulated  gelatin,  l^  cup  lemon  juice. 
%  cup  cold  water.  Whites  3  eggs. 

1  cup  boiling  water.  1  teaspoon  lemon  extract. 

Soften  gelatin  in  cold  water,  add  boiling  water  and  dis- 
solve. Add  sugar,  fruit  juice  and  extract,  and  stir  until 
sugar  is  dissolved.  Set  bowl  into  chopped  ice,  or  ice  water, 
to  cool,  stirring  occasionally;  when  jelly  is  quite  thick  fold 
in  the  stiffly-beaten  whites  of  eggs,  and  put  into  cold,  wet 
molds.  Put  on  ice  to  harden.  When  firm,  remove  from 
molds  and  serve  with  Soft  Custard  No.  1. 

SNOW  PUDDING,  222  CALORIES 

(Individual  Rule.) 

2  teaspoons  granulated  gelatin,    ll^  tablespoons  lemon  juice. 

3  tablespoons  cold  water.  3  tablespoons  sugar. 
Vg  cup  boiling  water.  White  1  egg. 

Make  same  as  preceding. 


310 


ANIMAL  FOODS 


SPANISH  CREAM,  912  CALORIES 

(Three  Servings.) 
1/4  box  shredded  gelatin  or  Yolks  3  eggs. 

1  tablespoon  granulated  gelatin.    6  tablespoons  sugar. 
l^  cup  cold  water.  14  teaspoon  salt. 

1/2  cup  boiling  water.  Whites  3  eggs. 

2  cups  milk.  1  teaspoon  vanilla. 

Soften  the  gelatin  in  the  cold  water^  add  the  boiling  water 
and  dissolve.  Heat  the  milk  in  a  double-boiler.  Beat  the 
yolk  of  eggS;,  add  sugar  axid  salt^  and  pour  the  hot  milk 
gradually  onto  the  mixture.  Eeturn  to  double-boiler  and 
cook  until  it  thickens^  stirring  constantly.  Add  the  strained 
gelatin  and  the  flavoring,  and  fold  in  carefully  the  well- 
beaten  whites.  Pour  into  cold,  wet  molds  to  harden.  Serve 
with  Soft  Custard  No.  1,  or  with  Whipped  Cream. 

SPANISH  CREAM,  303  CALORIES 

(Individual  Rule.) 
1  teaspoon  granulated  gelatin.      2  tablespoons  sugar. 
1  tablespoon  cold  water.  Speck  salt. 

3  tablespoons  boiling  water.  White  1  egg. 

2/3  cup  milk.  14  teaspoon  vanilla. 

Yolk  1  egg. 

Make  same  as  preceding^  and  serve  with  Orange  Sauce. 

ORANGE  SAXJCE,  136  CALORIES 

(Three  Servings.) 
Beat  white  of  one  egg  very  lights  add  two  tablespoons  sugar 
gradually^  beating  constantly,  then  add  one  and  one-half 
tablespoon  orange  juice  and  one  teaspoon  lemon  juice. 

BAVARIAN  CREAM,  205  CALORIES 

(Individual  Rule.) 
1  teaspoon  gelatin.  %  tablespoon  sugar. 

1  tablespoon  cold  water.  %  teaspoon  vanilla. 

14  cup  milk.  14  cup  whipped  cream. 

Yolk  1  egg. 

Soak  gelatin  in  cold  water  5  minutes.  Heat  the  milk  and 
pour  into  the  beaten  yolk  of  egg  and  add  this  mixture  to  gela- 


GELATIN 


211 


tin;  stir  until  gelatin  is  dissolved  and  flavor.  Set  in  ice  water 
to  cool;,  beating  almost  constantly.  When  it  begins  to  stiffen^ 
fold  in  the  whipped  cream.  Pour  into  molds.  Serve  with 
whipped  cream. 

Xote. —  Chocolate  may  be  added  by  omitting  flavoring  and 
add  chocolate  to  hot  milk  and  dissolve  before  adding  to  the 

yolk. 

GRAPE  FLTJFr,  957  CALORIES 

(Six  Servings.) 

14  box  shredded  gelatin  or  1  cup  Welch's  grape  juice. 

1  tablespoon  granulated  gelatin.  Juice  1  lemon. 
%  cup  cold  water.  Whites  3  eggs. 
%  cup  sugar. 

Soften  the  gelatin  in  cold  water  and  dissolve  by  standing 
the  dish  in  hot  water.  Dissolve  the  sugar  in  the  fruit  juicC;, 
and  strain  the  gelatin  into  it.  Set  in  ice  and  water^  and 
stir  occasionally  until  the  mixture  begins  to  thicken^  then 
add  gradually  the  well-beaten  whites  of  eggs,  and  beat  until 
the  whole  is  very  light  and  stiff  enough  to  hold  its  shape. 
Pile  lightly  in  glass  serving-dish,  or  mold  and  serve  with 
Whipped  Cream  or  Soft  Custard. 

ORANGE  CHARLOTTE,  350  CALORIES 

(Individual  Rule.) 

2  teaspoons  gelatin.  3  tablespoons  orange  juice. 
1  tablespoon  cold  water.  1  tablespoon  lemon  juice. 
1/3  cup  boiling  water.                   Whites  2  eggs. 

1/3  cup  sugar. 

Blend  as  for  Orange  Gelatin  and  set  the  bowl  into  chopped 
ice  or  ice-water  to  cool;  stir  occasionally.  When  jelly  is 
quite  thick^  fold  in  the  stiffly-beaten  whites  of  eggs.  Mix 
well  and  pour  into  cold^  wet  molds.  Put  on  ice  to  harden. 
When  firm^  remove  by  dipping  mold  quickly  in  warm  water; 
loosen  with  knife,  allowing  air  to  enter.  Serve  with  Soft 
Custard  No.  1. 

Note. —  Line  molds  with  lady  fingers  or  slices  of  sponge 
cake  and  pour  in  the  charlotte. 


212 


ANIMAL  FOODS 


STRAWBERRY  MOUSSE,  2284  CALORIES 

(Six  Servings.) 
^  box  shredded  gelatin  or  1  pint  thick  cream. 

1  tablespoon  granulated  gelatin.  %  cup  powdered  sugar. 
1/4  cup  cold  water.  1  cup  strawberry  juice. 

l^  cup  boiling  water. 

Soften  the  gelatin  in  the  cold  water ;  add  the  boiling  water 
and  dissolve.  Whip  the  cream  until  stiff,  and  add  the  pow- 
dered sugar.  To  the  gelatin  add  the  strawberry  juice,  fold 
the  cream  in  carefully,  turn  into  a  wet  mold  and  pack  in 
salt  and  ice  for  two  hours.  When  ready  to  serve,  turn  out  of 
mold  onto  a  large  glass  dish  and  garnish  with  fresh  straw- 
berries and  whipped  cream. 

THE  MADE-IN-A-MINUTE  DESSERT,  395  CALORIES 

Dissolve  one  package  of  Jell-0  in  one  pint  of  boiling  water. 
Pour  into  a  mould  and  put  in  a  cold  place  to  harden.  When 
set  turn  out  on  a  plate  and  serve  with  whipped  cream.  Wine 
Jelly  can  be  easily  made  by  using  one-fourth  cup  of  good 
wine  with  the  Lemon  Jell-0,  and  using  that  much  less 
water. 

JEILO-0  BAVARIAN  CREAM,  730  CALORIES 

One  package  of  Lemon  (or  other  flavor)  Jell-0,  one  pint 
of  boiling  water;  dissolve,  and  when  cool,  but  not  jellied, 
place  in  a  pan  of  ice-water  and  whip  with  dover  egg  beater 
until  the  consistency  of  a  thick  whipped  cream.  Then  add 
one-half  cup  of  grated  pineapple  (or  other  fruit)  and  one- 
half  cup  of  cream  whipped.    Will  serve  twelve  or  more. 

BEEF  PREPARATIONS 

BEEF  JUICE  — BEEF  TEA  — RAW  BEEF 
BEEF  JUICE 

Composition.  The  juice  of  meat  contains  considerable  pro- 
tein, in  addition  to  salts  and  extractives. 

General  Principles  in  Coohing.  From  raw  meat  we  can- 
not obtain  as  much  meat  juice  as  is  easily  taken  from  the  same 
amount  of  meat  when  previously  heated. 

1  Calculated  without  fruit. 


BEEF  PREPARATIONS 


213 


The  reason  for  this  is  that  the  envelope  enclosing  the 
muscular  tissue  is  a  tough  substance,  which  swells  and  dis- 
solves when  heated,  yielding  gelatin,  and  the  liquid  portion 
of  the  meat  is  easily  expressed.  If  cooked  too  long  the  pro- 
tein largely  coagulates  and  the  meat  loses  most  of  its  moisture 
and  becomes  tough. 

A  steak  thoroughly  heated  through  swells,  and  when  cut 
the  liquid  portion  flows  out  readily.  One  pound  of  meat 
yields  about  four  ounces  of  juice. 

Care  in  Serving.  In  administering  beef  juice  great  care 
should  be  taken  in  reheating  not  to  heat  it  above  136  degrees 
Fahrenheit,  at  which  temperature  albumin  coagulates  in 
flakes. 

Substitutes  for  Beef  Juice.  A  solution  of  white  of  egg 
flavored  with  meat  extract  makes  a  cheap  and  efficient  sub- 
stitute for  beef  juice. 

Prepared  extracts  of  good  make  may  be  used  to  advantage 
with  beef  juice  to  add  flavor  and  make  it  more  appetizing. 

Absorption.  Beef  juice  is  absorbed  in  the  rectum  to  nearly 
the  same  extent  as  complete  peptones  and  is  an  excellent 
article  of  diet  where  solid  foods  cannot  be  given. 

Comparative  Food  Value  of  Beef  Juice  and  Beef  Tea. 
Beef  juice,  although  fourteen  times  as  rich  in  protein  as 
beef  tea,  is  raw  in  flavor,  and  is  rejected  by  many  palates. 
In  such  a  case,  add  a  small  quantity  of  beef  tea  or  prepared 
beef  extract  for  flavor. 

Thus  by  the  union  of  two  bodies,  one  rich  in  protein  and 
the  other  rich  in  flavor,  we  have  a  superior  food.  Prepare 
a  small  quantity  at  a  time,  as  it  does  not  keep  well. 

BEEF  TEA 

Composition.  Meat  treated  with  hot  water  contains  only 
a  small  percentage  of  solids  and  almost  no  protein  except 
extractive  matter  and  soluble  mineral  matter.  The  clear 
liquid  which  remains  when  the  coagulated  albumin  is  strained 
out  of  beef  tea  contains  only  extractive  or  flavoring  sub- 
stances with  the  soluble  mineral  matter  of  the  meat.  There- 


214 


ANIMAL  FOODS 


fore  it  should  not  be  strained^,  and  if  properly  prepared  the 
albumin  will  not  be  coagulated  to  so  great  an  extent. 

Even  in  strong  beef  tea  which  is  carefully  made  the  amount 
of  proteids  present  has  been  found  to  be  less  than  2  per  cent. 

Nutritive  Value.  Beef  tea  is  valuable  in  the  sick  room  not 
as  a  food,  but  as  a  flavoring;  the  liquid  with  the  heat  of  the 
water  acts  as  a  stimulant. 

Beef  Extracts  are  prepared  in  both  liquid  and  solid  form. 
They  have  but  slight  nutritive  value,  containing  but  4  to  5 
per  cent,  of  protein,  but  are  valuable  for  their  flavoring  prop- 
erties. They  are  used  to  advantage  in  combination  with  beef 
juice,  adding  flavoring  and  making  it  more  palatable  and 
appetizing. 

EAW  BEEF 

TJncooTced  Meat.  Eaw  meat  is  not  quite  as  easily  digested 
as  cooked  meat,  and  owing  to  color  and  flavor  is  not  appetiz- 
ing, and  could  not  be  taken  continuously.  However,  when 
chopped  fine,  or  scraped  free  from  connective  tissue,  it  is 
very  readily  digested  and  can  be  served  disguised  or  very 
slightly  cooked  in  many  dainty  ways. 

Comparative  Food  Value  of  Raw  Beef  and  Beef  Tea.  It 
can  readily  be  seen  that  raw  meat  served  chopped  fine  or 
scraped  contains  all  the  nutriment  of  the  meat,  whereas  beef 
tea  as  seen  from  the  manner  of  preparation,  contains  only  the 
extractives  and  soluble  mineral  matter  of  meat. 

BEEF  JUICE 

100  grams  (3%  oz.)  =25  Calories. 
Select  a  piece  of  meat  from  the  rump  or  top  of  the  round. 
Uemove  all  fat  and  broil  or  warm  slightly  one  or  two  min- 
utes, to  set  free  the  juices;  lay  on  plate  and  cut  meat  in 
various  directions  that  more  juice  may  be  extracted;  then 
squeeze  out  the  juice  by  means  of  a  press,  lemon  squeezer  or 
potato  ricer  into  a  slightly  warmed  cup.  Salt  if  necessary, 
and  serve  at  once.  Prepare  only  enough  to  serve,  as  it  does 
not  keep  well.  Serve  in  dainty  china  cup  to  disguise  color. 
One  pound  of  meat  yields  four  ounces  of  juice. 


BEEF  PREPARATIONS 


215 


BEEF  JUICE  (FOR  INFANTS),  20  CALORIES 

This  food  is  very  useful  in  forms  of  diarrhoea  and  dysen- 
tery. A  half  pound  of  chopped  lean  meat  is  made  into  an 
oval,  flat  mass,  placed  on  a  broiler  and  slightly  browned. 
The  juice  is  then  expressed  with  a  small  meat  press,  mixed 
with  equal  parts  of  barley  water  and  salted  to  suit  the  taste. — 
Koplik. 

BEEF  ESSENCE 

100  grams  (Si/g  oz.)  =:23  Calories. 

Put  one-half  pound  round  steak  (freed  from  fat,  etc.) 
through  a  meat  chopper ;  put  into  small  glass  fruit  jar  with 
one  tablespoon  cold  water.  Place  jar  in  a  kettle  of  cold 
water,  heat  gradually  and  keep  at  temperature  150  degrees 
Fahrenheit  (which  is  62  degrees  below  the  boiling  point  of 
water)  for  two  hours.  Strain  and  press  the  meat  to  obtain 
all  the  juice.  Season  with  salt.  Serve  in  slightly"  heated 
dainty  china  cup  to  disguise  color. 

Note. —  A  small  piece  of  raw  beef,  broiled  slightly,  then 
cut  up  and  added  to  above,  gives  a  better  flavor. 

Liquid  thus  obtained  should  be  red  with  albuminous  juice 
in  solution  and  not  coagulated;  it  is  nutritious,  and  may  be 
kept  in  refrigerator  twelve  hours.  Serve  in  small  quantity 
slightly  heated;  or  it  may  be  made  into  beef  tea  by  diluting 
with  boiling  water.  Beef  essence  given  ice  cold  is  often 
grateful  to  a  fever  patient. 

IiaUID  PEPTONOIDS,  28  CALORIES 

Add  one  tablespoonful  of  Liquid  Peptonoids  to  one-half 
cup  of  boiling  water;  add  pinch  of  salt.  Sip  slowly.  This 
will  be  found  particularly  grateful  in  painful  affections  of 
the  throat. 

Note. —  To  serve  cold,  pour  one  tablespoonful  Liquid  Pep- 
tonoids over  a  small  glass  of  finely  cracked  ice.  Allow  it  to 
chill  thoroughly  and  sip  slowly. 


t  %  pound  steak. 
1  cup  cold  water. 


BEEF  TEA 
Salt. 


216 


ANIMAL  FOODS 


Wipe  steak,  remove  all  fat  and  cut  in  small  pieces.  Put 
in  glass  fruit  jar,  add  the  cold  water  and  let  it  stand  fifteen 
minutes  to  draw  out  the  juice.  Cover  jar,  using  rubber  band 
and  cover,  place  on  trivet  in  a  kettle  and  surround  with  cold 
water.  Allow  water  to  heat  slowly  to  150°  P.  (no  higher), 
and  keep  at  this  temperature  two  hours.  Strain  and  season 
with  salt.  Eemove  fat  with  soft  paper  or  bread.  Eeheat 
over  hot  water  to  130°  P.  and  serve  in  heated  cups. 

Note. —  If  possible  cool  beef  tea  before  serving  that  fat  may 
be  removed  more  thoroughly. 

BEEF  TEA  FROZEN 

Beef  tea  may  be  frozen  to  the  consistency  of  a  water  ice. 
Very  grateful  to  a  fever  patient. 

BEEF  TEA  WITH  HYDROCHLORIC  ACID 

100  grams  (3%  oz.)  =25  Calories.i 
Select  one-half  pound  of  good  beef ;  remove  everything  that 
is  not  clear  meat.  Chop  it  fine.  Put  in  pint  fruit  jar  and 
add  one  cup  cold  water  and  five  drops  dilute  hydrochloric  acid. 
Stir  and  set  in  refrigerator  or  any  cold  place  for  two  hours 
to  digest.  Then  strain,  season  with  salt  and  serve  in  some 
dainty  china  cup  on  account  of  color.  If  one  should  object 
to  color,  heat  the  tea  in  a  double  boiler  just  till  color  changes. 
Do  not  strain.  Beef  tea  made  in  this  way  is  recommended 
by  physicians  for  feeble  children  and  patients  much  weakened 
by  sickness. 

ICED  PANOPEPTON,  30  CALORIES 

To  a  small  glass  half-full  of  clean  crushed  ice  add  one 
tablespoonf ul  of  Panopepton ;  let  it  stand  a  moment  and  then 
sip  slowly. 

PANOPEPTON  — HOT,  36  CALORIES 

To  a  small  teacup  two-thirds  full  of  boiling  water,  add  one 
tablespoonful  of  Panopepton,  and  one  teaspoonful  of  fresh 
lemon  juice  —  a  little  sugar^  if  desired  —  stir.    Drink  im- 

^  Calculated  as  beef  juice. 


BROTH  AND  MEAT  JELLIES  217 


mediately,  sipping  slowly.  This  gives  a  pleasant  sense  of 
warmth  when  one  is  chilly,  and  is  excellent  in  cases  where 
light  nourishment  is  required  before  retiring. 

SCRAPED  BEEF 

100  grams  =  142  Calories. 

Wipe  a  small  piece  of  steak,  cut  from  top  of  round.  Lay 
it  on  a  meat  board,  and  with  a  sharp  knife  scrape  off  the  soft 
part  until  there  is  nothing  left  but  the  tough,  stringy  fibers. 
Make  it  into  little  flat,  round  cakes  half  an  inch  thick  and 
broil  them  two  minutes.  Season  with  salt  and  pepper  if 
allowed.  Serve  on  rounds  of  buttered  toast.  Do  not  add 
salt  before  cooking,  as  it  toughens  the  meat. 

RAW  BEEF  SANDWICHES 

1  ounce  scraped  beef  =3  40  Calories. 

1  ounce  bread  (1  slice)   =73  Calories. 

Prepare  meat  as  for  scraped  beef,  season  and  spread  on 
bread  cut  very  thin.  Put  slices  on  top,  sandwich-fashion^ 
and  cut  in  fancy  shapes.  Serve  in  this  manner  or  toast 
daintily. 

BROTH  AND  MEAT  JELLIES 

Broth  is  a  liquid  containing  the  juices  of  soluble  parts  of 
meat  and  bone,  which  have  been  extracted  by  long,  slow  cook- 
ing. 

This  liquid  is  more  or  less  solid  when  cold,  according  to  the 
gelatinous  nature  of  the  ingredients.  It  varies  greatly  in 
quantity,  according  to  the  manner  in  which  it  is  prepared 
and  the  material  used.  The  cheaper,  inferior  parts  of  meat 
yield  more  nutriment  than  the  expensive  cuts. 

Composition.  Broth  contains  almost  no  protein  except  ex- 
,  tractive  matter  with  soluble  mineral  matter  and  gelatin. 

Objective  Point  and  General  Principles  in  Cooking,  The 
chief  object  in  making  broth  is  to  obtain  the  largest  possible 
amount  of  nutriment  from  the  meat.  This  is  best  accom- 
plished by  observing  the  following  rules : 


218 


ANIMAL  FOODS 


Cut  meat  into  small  pieces. 

Soak  in  the  cold  water  before  heating. 

Use  a  careful  selection  and  proportion  of  meat^  bone  and 
water.  (The  usual  proportion  is  one  pint  of  water  to  one 
pound  of  meat.) 

Season  judiciously. 

Use  steam-tight  kettle;  simmer  (not  boil)^  that  the  juice 
may  be  fully  extracted. 

Make  it  the  day  before  using^  that  the  fat  may  be  removed 
more  easily. 

Long^  slow  cooking. 

Broth  may  be  made  from  beef,  mutton  or  chicken.  Eice, 
barley,  white  or  whole  egg,  etc.,  may  be  added,  if  allowed,  to 
increase  the  quantity  of  nourishment. 

Comparative  Value  of  Broth  and  Beef  Tea.  Broth  differs 
from  beef  tea  in  that  it  contains  gelatin,  besides  the  extrac- 
tives or  flavoring  substances  and  soluble  mineral  matter  that 
are  found  in  beef  tea.  Gelatin  is  obtained  from  meat  and 
bones  by  long,  slow  cookings  and  it  is  useful  in  convalescence 
and  in  febrile  states.    (Note    Gelatin,^'  p.  203.) 

Meat  Jellies  are  a  condensed  form  of  broth,  which  forms  an 
agreeable  way  of  serving  protein  food  to  an  invalid,  and  are 
especially  valuable  in  febrile  states.  Although  they  do  not 
entirely  replace  protein  in  the  diet,  they  produce  a  consid- 
erable quantity  of  energy.  (Note  Gelatin,^^  p.  203,  for 
nutritive  value.) 
, Prepared  Broths  ready  for  immediate  use;  see  page  491. 


Very  few  analyses  of  broths  are  available ;  hence  no  attempt 
has  been  made  to  state  the  calories  under  each  recipe.  The 
following  table  gives  an  approximate  idea  of  their  energy 
value : 


ENERGY  VALTTE  OP  BROTH 


Beef  broth 
Beef  juice 


100  grams  yield  16.5  Calories. 
100  grams  yield  25  Calories. 
100  grams  yield  2  Calories. 
100  grams  yield  12  Calories. 


Clam  bouillon 
Consomme  . . . 


BROTH 


219 


Food  that  may  be  added  for  extra  nutriment 
1  whole  egg  (average)  ....  45  grams  yield  60  Calories. 
White  of  1  egg  (average)  .  25  grams  yield  13  Calories. 
Yolk  of  1  egg  (average)  . .  13  grams  yield  48  Calories. 

1  tablespoon  rice   15  grams  yield  50  Calories. 

1  tablespoon  barley  27  grams  yield  90  Calories. 

MUTTON  BROTH 

2  pounds  mutton,  cut  from  fore-  Speck  pepper. 

quarters.  2  tablespoons  boiled  rice  or  bar- 

1  quart  cold  water.  ley. 
1  teaspoon  salt. 

Wipe  meat^  remove  skin  and  fat  and  cut  into  small  pieces. 
Put  in  a  kettle  with  bones  that  have  been  well  broken^  add 
cold  water  and  let  it  stand  one-half  hour  to  extract  the  juices. 
Heat  gradually  to  boiling  pointy  skim^  and  when  partly  cooked 
season  with  salt  and  pepper.  Simmer  four  hours^  or  until 
meat  is  tender.  Do  not  allow  it  to  boil.  Eemove  fat  and 
strain  through  a  coarse  sieve.  Serve  hot.  If  broth  is  made 
the  day  before  it  is  used;,  it  can  be  cooled  thoroughly  and 
the  fat  be  removed  easily.  In  reheating  use  double  boiler. 
Two  tablespoons  of  cooked  rice  or  barley  may  be  added  if 
desired.  The  barley  should  be  soaked  over  night  or  several 
hours  before  cooking.  Taste  and  season  before  serving,  a  tea- 
spoon of  chopped  parsley  may  be  added  just  before  serving 
if  desired. 

Note. —  For  weaker  broth,  use  one  quart  of  water  to  one 
pound  of  meat. 

BEEF  BROTH 

Prepared  same  as  Mutton  Broth. 

BROTH  WITH  GRAINS 

1  quart  hot  broth.  1  tablespoon  rice  or  barley. 

To  the  hot  broth  add  the  well-washed  rice.  Simmer  slowly 
until  the  rice  is  tender,  adding  more  broth  if  it  evaporates. 
The  broth  should  be  strained  before  using. 


320 


ANIMAL  FOODS 


CHICKEN  BROTH 

pounds  chicken.  1  teaspoon  salt. 

3  pints  cold  water.  Speck  pepper. 

2  tablespoons  rice. 

Thoroughly  clean  a  chicken  (see  Poultry/^  p.  153),  re- 
move skin  and  fat;  separate  at  the  joints  and  wipe  with  a 
wet  cloth.  Put  in  kettle  and  add  the  cold  water  and  let 
stand  one-half  hour.  Heat  very  slowly  and  simmer  three 
hours^  or  until  meat  is  tender.  When  half-cooked  skim  off 
fat  and  add  the  rice  and  seasonings  (and  if  desired,  a  small 
onion).  When  meat  is  tender,  skim  off  fat  and  strain,  taste 
and  season  properly  and  serve  hot.  When  possible,  make 
broth  the  day  before  using,  that  it  may  be  thoroughly  cooled 
and  the  fat  removed  easily.  Eeheat  in  a  double  boiler.  The 
rice  may  be  cooked^  and  rubbed  through  strainer  before  add- 
ing to  broth,  or  it  may  be  omitted  if  desired.  An  old  fowl, 
not  too  fat,  is  best  for  brpth. 

VEAL  BROTH 

Prepared  same  as  Chicken  Broth  (use  cut  from  loin  or 
knuckle  of  veal). 

CLAM  BROTH  NO.  I 

Take  five  clams,  wash  and  scrub  well  and  put  in  saucepan 
with  cold  water  to  cover.  Cook  until  shells  open,  remove 
from  pan  and  take  out  clams.  Chop  and  put  them  back  into 
broth.  Cook  fifteen  minutes.  Strain  through  muslin;  serve 
hot.    If  too  strong  flavor,  add  hot  water. 

Note. —  If  made  in  large  quantity,  use  two  or  three  clams 
to  one  cup  water. 

This  broth  may  be  frozen  to  the  consistency  of  a  frappe. 

CLAM  BROTH  NO.  II 

%  cup  clam  broth.  Pepper. 

1  cup  water  or  milk.  14  teaspoon  butter. 

Blend  the  clam  broth  and  water  (or  milk)^  and  heat  to  the 
boiling  point.  .  Season  with  salt  to  taste,  and  if  allowed,  a 
little  pepper  and  the  butter.    Serve  hot  in  dainty  cups. 


MEAT  JELLIES 


221 


EGG  BROTH 

If  one  cannot  conveniently  get  protein  from  meat,  a  very 
nutritions  broth  may  be  made  by  means  of  hot  water  into 
which  an  egg  has  been  stirred.  Heat  three  tablespoons  of 
water  to  not  above  149  degrees  Fahrenheit  (below  the  sim- 
mering point),  and  pour  it  gradually  into  a  raw  egg.  The 
liquid  is  milky  if  the  yolk  is  used;  clear  if  only  the  white  is 
used.  It  has  little  taste,  which  is  an  advantage  with  many 
patients ;  or  it  may  be  flavored  with  beef  extract. 

EGG  BROTH  NO.  II 

1  cup  hot  beef  broth.  %  teaspoon  salt. 

1  egg. 

Beat  the  white  and  yolk  of  egg  separately.  To  the  yolk 
add  gradually  the  hot  broth,  stirring  continually.  Add  the 
salt  and  fold  in  the  well-beaten  white.  Eeheat  in  double 
boiler,  taking  care  not  to  coagulate  the  albumin.  Serve  very 
hot. 

Note. —  The  white  or  yolk  of  egg  may  be  used  separately. 
MEAT  JELLIES 

CALF'S  FOOT  JELLY 

100  grams  =:  65  Calories. 

1  calf's  foot.  Rind  of  l^  lemon  (yellow  part 
1  quart  cold  water.  only). 

3  cups  sherry  wine  (best  Topaz),  l^  cup  cut  or  cube  sugar. 
Juice  of  one  lemon. 

Clean  calf ^s  foot  and  put  into  the  cold  water ;  bring  slowly 
to  boiling  point,  and  boil  five  hours ;  skim  if  necessary,  while 
cooking.  Strain  through  cheese-cloth  and  allow  it  to  stand 
until  firm  and  remove  the  fat. 

Mix  lemon  juice,  wine,  the  whites  and  shells  of  eggs,  sugar, 
and  beat  all  together  until  the  sugar  is  dissolved,  then  add  to 
the  jelly.  Place  on  the  fire  in  an  enamel  stewpan^  and  stir 
constantly  until  the  mixture  is  very  hot,  but  not  boiling; 
strain  through  a  jelly  bag,  made  of  cotton  flannel,  and  allow 


222 


ANIMAL  FOODS 


the  jelly  to  drip  through  same  slowly,  pour  into  molds  or 
glass  jars,  and  put  in  cold  place  to  harden. 

Note. —  Several  varieties  may  be  made  by  substituting  the 
different  flavors,  brandy,  rum,  port  wine,  champagne,  orange 
and  lemon  juice. 

CHICKEN  JELLY 

3  pounds  chicken.  8  peppercorns. 

1  quart  cold  water.  Salt. 

Prepare  chicken  as  for  chicken  broth  and  cut  flesh  and 
bone  into  small  pieces.  Put  into  saucepan  with  cold  water 
and  peppercorns  and  let  stand  one-half  hour.  Bring  slowly 
to  the  boiling  point,  remove  scum  and  cook  five  or  six  hours 
or  until  meat  is  very  tender  and  water  is  reduced  to  one  pint, 
while  cooking  keep  it  below  the  boiling  point.  Skim  fre- 
quently while  cooking,  strain  through  double  thickness  of 
cheese-cloth,  season  to  taste  and  let  stand  until  firm.  Ee- 
move  fat,  reheat  and  turn  into  glass  fruit  jars  or  individual 
molds  and  cool ;  put  in  ice  box  until  jellied. 

Additional  flavor  may  be  added  if  desired,  a  stalk  of  celery 
or  a  small  piece  of  bay  leaf  may  be  cooked  with  the  chicken. 

Note. —  Mutton  Broth  Jelly  may  be  treated  in  the  same 
way. 

BEEF  JELLY 

3  pounds  solid  meat  from  the  4  quarts  cold  water. 

shoulder  or  shin.  2  teaspoons  salt. 

3  pounds  bone  from  same. 

Take  off  the  dried  skin  and  any  soft  or  bloody  portion. 
Cut  the  meat  into  small  pieces  and  put  it  with  the  cracked 
bone  into  an  earthen  jar.  Cover  with  the  cold  water.  Set 
in  slow  oven  and  cook  from  eight  to  twelve  hours.  Strain 
through  a  colander.  Add  salt  to  taste;  cool  quickly.  When 
cold  remove  the  fat.  Serve  cold  as  a  jelly,  or  reheat  in 
double  boiler. 


SOUP 


223 


SOUP  AND  SOUP  ACCOMPANIMENTS 

Soup  is  a  light  and  suitable  form  of  food  for  the  sick. 
There  are  two  classes  —  those  made  with  meat  and  those 
without  meat. 

The  soups  with  meat  are  an  infusion  of  meat,  flavored  with 
salt  and  some  condiment.  They  are  treated  in  the  chapter 
on  broths. 

The  foundations  of  soups  without  meat  are  milk,  vegetables 
and  water.  They  are  dainty  and  nutritious,  and  an  excellent 
way  of  serving  milk  and  the  starch  and  mineral  matter  of  the 
vegetable. 

They  may  be  served  as  a  luncheon,  with  crisp  crackers,  or  as 
the  first  course  of  a  dinner.  Serve  daintily  in  heated  bouillon 
cups,  partly  filled,  on  small  plate  and  doily. 

General  Rule  for  blending: 

(a)  Prepare  vegetables,  cook  and  strain. 

(&)  Prepare  cream  sauce:  Melt  butter,  add  the  flour  and 
gradually  pour  on  the  scalded  milk  or  water.  Cook  thor- 
oughly. 

(c)  Blend  (a)  and  (&).  Season,  strain  and  serve  imme- 
diately. 

In  the  preparation  of  these  soups  great  care  must  be  taken 
that  the  starch  of  the  vegetable  and  of  the  flour  used  in  the 
thickening  is  thoroughly  cooked.  Cooking  temperature  of 
starch  is  212  degrees  Fahrenheit. 

CREAM  or  ASPARAGUS  SOUP,  313  CALORIES 

(Individual  Rule.) 
1/4  bundle  asparagus.  %  tablespoon  flour. 

1  cup  milk.  Salt. 
14  tablespoon  butter.  Pepper. 

(a)  Wash  the  asparagus  and  cook  in  boiling  salted  water, 
boiling  gently  thirty  minutes.  Take  from  the  water,  cut  off 
the  tips  and  put  them  into  the  serving  dish;  press  the  re- 
mainder through  a  colander. 

(&)  Scald  the  milk.    Melt  the  butter,  add  the  flour  and 


224 


ANIMAL  FOODS 


pour  on  gradually  the  scalding  milk.  Cook  thoroughly,  stir- 
ring often. 

Blend  (a)  and  (&)  ;  reheat,  season  to  taste,  strain  over  tips 
and  serve  at  once  with  crisped  wafer  crackers. 

Note. —  For  individual  quantity  use  one-half  recipe. 

CREAM  OF  CORN  SOUP,  493  CALORIES 

(Two  Servings.) 
%  cup  corn.  1  cup  milk. 

%  cup  cold  water.  '  1  tablespoon  flour. 

l^  slice  onion.  1  tablespoon  butter. 

Salt  and  pepper.  Yolk  1  egg. 

(a)  Chop  corn,  add  water  and  simmer  twenty  minutes; 
rub  through  a  sieve. 

(&)  Scald  milk  with  onion;  remove  onion.  Melt  butter, 
add  flour  and  gradually  pour  on  milk. 

Blend  {a)  and  (&)  ;  cook  thoroughly,  season  to  taste  with 
salt  and  pepper  and  pour  onto  the  beaten  yolk.  When  well 
blended,  serve  hot. 

Note. —  The  yolk  of  egg  may  be  omitted. 

CREAM  OF  CELERY  SOUP,  320  CALORIES 

(Two  Servings.) 
4  stalks  celery.  1  tablespoon  butter. 

%  cup  boiling  water.  1  tablespoon  flour. 

Salt  and  pepper.  1  cup  rich  milk. 

(a)  Wash  and  scrape  the  celery  and  cut  into  small  pieces, 
add  the  water  and  cook  until  very  tender  and  soft.  Eenew 
the  water  if  it  boils  away.  Mash  the  celery  in  the  water  in 
which  it  was  cooked. 

(&)  Scald  milk.  Melt  the  butter  in  a  saucepan,  add  flour 
and  pour  on  gradually  the  scalded  milk.  Cook  thoroughly, 
stirring  carefully. 

Blend  {a)  and  (&) ;  season  to  taste;  strain  and  serve  im- 
mediately with  croutons  or  crisped  crackers. 


SOUP 


225 


CREAM  OF  CELERY  SOUP  (FOR  THE  DIABETIC),  226  CALORIES 

(Three  Servings.) 
6  stalks  celery.  Speck  cayenne  pepper,  salt. 

1  slice  onion.  %  teaspoon  butter. 

1  cup  water.     1  cup  hot  milk.     %  teaspoon  Gum  Gluten  Flour. 

Boil;,  mash  and  strain  the  first  three  ingredients,  add  the 
hot  milk  or  cream.  Melt  the  butter,  add  the  flour  and  pour 
on  gradually  the  hot  soup  stock;  season  and  cook  thoroughly. 

CREAM  OF  PEA  SOTIP,  215  CALORIES 

(Individual  Rule.) 

l^  can  peas.  %  cup  milk. 

%  teaspoon  sugar.  %  tablespoon  butter. 

^  cup  cold  water.  %  tablespoon  flour. 

Salt  and  pepper. 

(a)  Drain  peas  from  their  liquor,  rinse  thoroughly,  add 
sugar  and  cold  water  and  simmer  twenty  minutes.  Eub 
through  a  sieve;  reheat. 

(&)  Scald  milk.  Melt  butter,  add  flour  and  pour  on  grad- 
ually the  scalding  milk.    Cook  thoroughly,  stirring  carefully. 

CREAM  OF  PEA  FLOUR  SOUP  P.  202  CALORIES 

(Individual  Rule.) 
1  tablespoon  pea  flour.  Salt. 
1  cup  cold  milk.  Pepper. 

Put  the  pea  flour  into  a  saucepan  and  pour  on  gradually 
the  cold  milk.  Cook  over  direct  heat,  stirring  constantly 
until  flour  is  thoroughly  cooked  (about  10  or  15  minutes). 
Season  with  salt  and  pepper,  serve  hot.  Bean,  lentil,  rice 
or  barley  flour  may  be  used  in  the  same  way. 

Note. —  In  making  a  large  quantity  use  double  boiler. 
Cook  over  direct  heat  10  minutes  and  place  over  hot  water. 
CREAM  OF  ONION  SOUP,  297  CALORIES 
(Individual  Rule.) 

1  onion.  %  tablespoon  butter. 

1  cup  milk.  %  tablespoon  flour. 

Cut  onion  in  small  pieces  and  scald  in  milk.  Melt  butter, 
add  flour  and  add  gradually  the  milk  mixture  and  cook  well. 
Season  with  salt  and  pepper  and  strain. 


226 


ANIMAL  FOODS 


ONION  SOUP  (FOR  THE  DIABETIC),  30  CALORIES 

One  Bermuda  or  three  green  onions  boiled  nntil  tender  in 
stock  or  water ;  mash  and  strain.  Add  one-half  teaspoon  Gum 
Gluten  Flour^  one-half  teaspoonful  butter  and  a  little  chopped 
parsley.    One  tablespoon  of  cream^  if  desired. 

CREAM  OF  POTATO  SOUP,  220  CALORIES 

(Individual  Rule.) 
%  cup  milk.  l^  tablespoon  flour. 

14  slice  onion.  ^4  teaspoon  salt. 

l^  cup  mashed  potatoes.  Pepper. 
%  tablespoon  butter. 

(a)  Scald  milk  with  onion  in  it,  remove  onion  and  add  milk 
slowly  to  potatoes,  (b)  Melt  butter,  add  flour  and  pour  on 
gradually  the  hot  mixture.  Cook  thoroughly  and  season  to 
taste.  A  little  celery  salt  may  be  added  if  desired.  A  little 
finely-chopped  parsley  may  be  sprinkled  over  top  of  soup. 

CREAM  OF  RICE  SOUP,  302  CALORIES 

(Individual  Rule.) 
1  tablespoon  rice.  Stalk  celery. 

1  cup  milk.  Vs  bay  leaf. 

%  tablespoon  butter.  Salt. 
%  small  onion.  Pepper. 

Scald  the  milk^  add  the  well-washed  rice  and  cook  in  double 
boiler  thirty  minutes,  covered  closely. 

Melt  butter  in  saute  pan,  add  the  sliced  onion  and  cook  till 
tender,  but  not  brown.  Add  celery  sliced,  and  turn  into 
scalded  milk;  add  the  bay  leaf,  cover  and  let  stand  on  back 
of  stove  fifteen  minutes.  Strain,  season  with  salt  and  pepper, 
reheat  and  serve. 

Note. —  If  soup  is  too  thick,  add  a  little  heated  milk. 

TOMATO  SOUP  (WITH  BROTH),  110  CALORIES 

(Individual  Rule.) 
%  cup  strained  tomatoes.  1  cup  water  or  stock. 

l^  tablespoon  butter.  l^  teaspoon  salt. 

l^  slice  onion.  Speck  pepper. 

1  tablespoon  flour. 


SOUP 


227 


(a)  Cook  and  strain  tomatoes,  obtaining  one-half  cup 
juice. 

(6)  Melt  butter,  add  the  onion  and  brown  slightly;  add 
the  flour ;  pour  on  gradually  the  boiling  water  or  stock. 

Blend  (a)  and  (6)  ;  cook  thoroughly,  season  with  salt  and 
pepper,  strain  and  serve. 

Xote. —  Two  tablespoons  of  cream  may  be  added. 

Beef  or  mutton  broth  strained  may  be  used  in  place  of 
water  if  desired. 

CREAM  OF  TOMATO  SOITP  (FOR  THE  DIABETIC),  224  CALORIES 

(Two  Servings.) 
%  cup  tomatoes.  l^  teaspoon  butter. 

1  slice  onion.  %  teaspoon  Gum  Gluten  Flour. 

1  cup  milk.  Salt,  pepper. 

Stew  and  strain  the  tomatoes  and  onion,  reheat  and  add 
a  tiny  pinch  of  soda.  When  effervescing  subsides  add  milk. 
Melt  the  butter,  add  the  flour  and  pour  in  gradually  the  hot 
stock.    Season  and  cook  thoroughly. 

MOCK  BISaUE  SOUP,  324  CALORIES 

(Individual  Rule.) 
%  cup  tomatoes.  1  tablespoon  butter. 

%  saltspoon  soda.  %    tablespoons    flour   or  corn- 

Salt  and  pepper.  starch. 
1  cup  milk. 

(a)  Steam  tomatoes  until  soft  enough  to  strain  juice; 
strain,  add  soda  and  allow  gases  to  pass  off.  This  prevents 
the  acid  of  the  tomato  curdling  the  milk. 

(&)  Scald  milk;  melt  butter  in  quart  size  saucepan,  add  the 
flour  and  pour  on  gradually  the  scalding  milk.  Cook  thor- 
oughly, stirring  carefully. 

Blend  (a)  and  (&)  ;  reheat,  season  to  taste,  strain  and 
serve  immediately  with  croutons  or  crackers. 

DRIED  FRUIT  SOUP,  209  CALORIES  i 

l^  cup  dried  apricots.  1  cup  cold  water. 

%  cup  prunes.  Sugar  to  taste. 


1  Without  sugar. 


228 


ANIMAL  FOODS 


Pick  over  and  wash  fruit  until  perfectly  clean.  Cook  in 
the  water  until  very  soft.  Strain  and  squeeze  out  all  the 
juice;  sweeten  to  taste.    Thicken  if  liked. 

Thickening. —  1  slightly  rounding  teaspoon  rice  flour  to 
1  cup  liquid.  Cook  twenty  minutes  to  remove  raw  taste  of 
starch. 

PANOPEPTON  BOiriLLON  — HOT,  30  CALORIES 

Put  one  tablespoonful  of  Panopepton  into  a  small  teacup; 
fill  the  cup  nearly  full  of  boiling  water^  and  flavor  to  taste 
with  celery  salt,  or  plain  salt  and  pepper ;  stir,  and  sip  slowly. 
This  is  a  very  nourishing  and  pleasantly  stimulating  drink. 

VICTORIA  SOTTP  (WITH  BROTH),  619  CALORIES 

(Two  Servings.) 
%  cup  lean  chicken  meat.  1  cup  rich  milk. 

1  cup  strong  chicken  broth.  %  cup  cracker  crumbs. 

%  teaspoon  salt.  Yolks  2  eggs. 

Pepper. 

Soak  the  crumbs  in  a  little  of  the  milk.  Cook  j^olks  of 
eggs  in  hot  water  until  hard.  Chop  the  chicken,  mix  with  the 
soaked  cracker  crumbs,  press  the  hard-cooked  yolks  through 
a  coarse  strainer,  add  the  seasonings  and  the  broth  and  cook 
all  together  five  minutes  over  direct  heat  or  one-half  hour  in 
double  boiler.    Serve  hot. 

CONSOMME 

Make  a  beef  or  any  broth  according  to  the  strength  re- 
quired. While  cooking  skim  frequently,  and  when  reduced 
to  one-third  of  its  quantity  take  from  saucepan  and  strain; 
season  well,  cool  quickly  and  remove  fat.  Eeturn  to  sauce- 
pan, add  a  few  thin  slices  of  onion  and  one-half  pound  of 
lean  beef  chopped  fine  and  clear. 

To  Clear  Soup,  To  each  quart  of  stock  add  the  slightly 
beaten  white  and  broken  shell  of  one  egg  and  a  few  shavings 
of  lemon  rind.  Place  on  front  of  range,  and  stir  constantly 
until  boiling  point  is  reached;  boil  two  minutes.  Set  back 
where  it  may  simmer  twenty  minutes ;  remove  scum  and  strain 
through  double  thickness  of  cheese-cloth. 


SOUP  ACCOMPANIMENTS  229 

OYSTER  SOUP 

See  chapter  "  Oysters    for  recipe.    Pages  171-173. 

OYSTER  STEW 

See    Oysters    for  recipe.    Page  173. 

CLAM  SOUP 

See  chapter  "  Clams    for  recipe.    Page  174. 

CLAM  BOUILLON 

See  chapter  "  Clams    for  recipe.    Page  174. 

CLAM  BOUILLON  BISQUE 

See  chapter    Clams    for  recipe.    Page  175. 

MEAT  SOUPS 

Foundation  for  same,  see  chapter    Broths/^    Page  319» 
SOUP  ACCOMPANIMENTS 

GLUTEN  BISCUIT  CRISPS 

1  =  25  Calories. 

Serve  plain  or  butter  slightly  and  bake  until  heated  through* 

CRISPED  CRACKERS 

1  Saltine=:15  Calories. 
Split  common  crackers  or  use  saltines.    Put  in  pan  and 
bake  until  thoroughly  heated.    Serve   plain   or  buttered 
slightly. 

TOASTED  CRACKERS 

Butter  crackers,  put  in  pan  and  bake  until  a  delicate  brown. 
Serve  on  small  plate  with  doily. 

CROUTONS 

1  ounce  (1  slice)  bread  =  73  Calories. 
Take  a  slice  of  stale  bread  about  half  an  inch  thick,  cut 
into  half -inch  cubes ;  put  them  in  a  shallow  pan  and  dry  thor- 
oughly, then  brown  delicately.    Stir  often  to  brown  evenly* 


230  ANIMAL  FOODS 

Serve  on  small  plate  with  doily.  A  little  butter  may  be 
spread  on  the  bread  if  desired. 

NOODLES  FOR  SOUP  (FOR  THE  DIABETIC),  596  CALORIES 

1  egg.  5  ounces  Gum  Gluten  Flour. 

1  tablespoon  milk. 

Beat  the  egg  very  light^  add  the  milk  and  Gum  Gluten. 
Eoll  very  thin  and  cut  in  straws.    Cook  in  any  soup. 

GLUTEN  CRISP  (FOR  THE  DIABETIC) 

See  chapter    Toast    for  recipe.    Page  256. 


CHAPTEE  X 


VEGETABLE  OR  PLANT  FOODS 

The  important  food  products  derived  from  the  vegetable 
kingdom  are  the  Cereals^  Legumes  —  Eoots  and  Tubers  — 
Green  Vegetables  —  Fruits  —  Nuts  —  Fungi  —  Lichens. 

Composition,  Vegetable  or  plant  foods  contain  the  five 
proximate  principles^  namely,  proteins,  fats,  carbohydrates,, 
water  and  mineral  matter.  In  this  they  resemble  animal 
foods.  The  food  principles  in  the  two  classes  are,  however,, 
in  different  proportions,  animal  foods  being  rich  in  proteins 
or  fats,  and  seldom  containing  carbohydrate  in  appreciable 
amounts;  while  vegetable  foods  are,  as  a  rule,  rich  in  carbo- 
hydrates,  and  poor  in  proteins  and  fats. 

These  differences  are  clearly  shown  in  the  following  table : 

Pro.  Fat.  Carb. 

%  %  % 

Lean  round  of  beef.    Free  from  all  vis- 
ible fat                                              23.2  2.5 

Lean  round  of  beef.    Very  fat                  16.1  23.1  .... 

Wheat  flour  (entire  wheat)                      13.8  1.9  71.9 

Potatoes                                                   1.8  0.1  14.7 

Apples                                                     1.6  2.2  66.1 

The  legumes  and  most  nuts  are  exceptional  in  containing 
high  percentages  of  protein  or  fat  or  both,  but  unlike  meats, 
they  also  contain  a  very  considerable  amount  of  carbohydrate,, 
as  shown  by  the  following  analyses : 

Pro.         Fat.  Carb. 
%  %  % 

Beans,  dried   22.5  1.8  59.6 

Peas    24.6  1.0  62.0 

Almonds    21.0  54.9  17.3 

Walnuts    16.6  63.4  16.1 

231 


232  VEGETABLE  OR  PLANT  FOODS 


Protein.^  (1)  Gluten  of  wheat  and  some  of  the  other 
cereals. 

(2)  Legumin  found  in  legumes. 

(3)  Vegetable  albumin  as  found  in  some  vegetables. 
Carbohydrates  of  Vegetables  ^  include  —  starchy  sugar^  veg- 
etable gums  and  cellulose. 

Fats  of  Vegetables  ^  are  in  the  form  of  oils  and  are  similar 
in  composition  to  animal  fats^  but  are  more  easily  digested 
and  equal  in  nutritive  value. 

Water,  Dry  vegetable  fobds^  such  as  cereals^  dried  beans 
and  peas^  nuts^  dried  fruits^  etc.^  do  not^  as  a  rule^  contain 
as  much  water  as  animal  foods,  but  fresh  vegetables  and  fruits 
contain  frequently  from  90  per  cent,  to  95  per  cent,  of  water. 

This  gives  them  a  low  nutritive  value  compared  with  their 
bulk.  In  cooking^  water  is  added  to  most  dry  vegetable  foods, 
so  that  when  served  they  resemble  fresh  or  succulent  vegetable 
foods  in  this  respect. 

Mineral  Matter,^  All  vegetable  foods  contain  valuable  ash 
constituents.  In  cereals,  these  are  largely  in  the  outer  part 
of  the  grain,  and  are  lost  if  the  entire  grain  is  not  utilized. 
Thus  polished  rice  is  much  poorer  in  ash  constituents  than 
unpolished;  and  white  flour  than  entire  wheat  flour.  Fresh 
vegetables  and  fruits  are  desirable  in  the  dietary  for  their 
salts  and  organic  acids. 

Digestibility,  Vegetable  foods  are  less  easily  digested  thar^ 
animal  foods,  owing  to  their  complex  composition,  and  espe- 
cially to  the  intimate  mixture  of  the  nutrients  with  cellulose. 
This  prevents  the  digestive  ferments  acting  readily  upon  the 
food-stuffs  so  that  they  are  digested  more  slowly  and  less  com- 
pletely than  animal  foods.  Although  cellulose  is  indigestible, 
its  presence  under  normal  conditions  in  proper  amounts,  is 
advantageous,^  but  it  should  be  thoroughly  softened  by  cook- 
ing, except  in  the  case  of  tender  young  vegetables  such  as 
lettuce. 

1  Protein,  see  p.  10. 

2  Carbohydrates,  see  p.  16. 

^  Fats  of  vegetables,  see  p.  20. 
*  Mineral  matter,  see  p.  31, 
5  See  p.  17. 


CEREALS 


233 


Comparative  Value  of  Animal  and  Vegetable  Diets.  An 
animal  diet  is  concentrated  and  easily  digested.  If  the  ani- 
mal foods  taken  are  eggs  and  milk^  no  serious  objection  can 
be  urged  against  them^  except  that  they  lack  bulk.  The  food 
is  so  fully  absorbed  that  the  large  intestine  has  no  stimulus 
to  action  and  no  material  for  its  muscles  to  act  upon,  and 
serious  complications  are  likely  to  arise  from  constipation. 
If  the  animal  food  is  largely  meat,  it  is  undesirable,  not  only 
for  the  reason  above  mentioned,  but  because  excessive  quan- 
tities of  nitrogenous  extractives  are  taken,  which  are  likely 
to  cause  uric  acid  disorders  and  other  disturbances,  and  also 
because  important  mineral  salts  are  lacking  (such  as  calcium^ 
which  carnivorous  animals  get  by  eating  bone)  ;  and  because 
the  acids  formed  from  the  protein  (phosphoric  and  sulphuric) 
tend  to  deprive  the  body  of  salts  already  present  in  the  tissues. 

A  strict  vegetable  diet,  on  the  other  hand,  while  free  from 
these  objections,  is  necessarily  very  bulky,  owing  to  the  high 
percentages  of  water  and  cellulose,  and  to  the  fact  that  extra 
allowance  must  be  made  because  it  is  less  perfectly  absorbed. 
Unless  special  care  is  taken,  a  vegetable  diet  is  also  likely  to 
be  low  in  protein.  Legumes  and  nuts  must  form  a  consid- 
erable part  of  the  dietary  to  provide  this.  When  eggs,  milk 
and  milk  products  are  added  to  the  vegetable  foods,  the  diet 
becomes  mixed,  and  these  objections  no  longer  hold. 

An  Ideal  Diet  contains  a  mixture  of  animal  and  vegetable 
foods,  so  that  protein,  fat,  carbohydrate  and  mineral  matter 
are  supplied  in  proper  proportions  and  in  available  forms,  and 
sufficient  bulk  is  afforded  for  proper  intestinal  action. 

CEREALS 

GRUELS  —  BREAKFAST    FOODS  —  STARCHY    JELLIES  —  MACA- 

RONI 

Wherever  it  is  possible  to  grow  grains,  they  are  staples  of 
man's  diet.  No  food  products  of  the  vegetable  kingdom  equal 
them  in  importance.  They  are  cheaply  and  easily  grown,  and 
contain  all  the  food  principles  in  unusually  good  proportion. 


234  VEGETABLE  OB  BLANT  FOODS 


They  can  be  kept  for  long  periods^  are  not  difficult  to  cook, 
and  furnish  a  palatable  and  digestible  article  of  diet.  Cereals 
alone  supply  nearly  one-fourth  of  the  total  food  in  a  large 
number  of  the  American  families.  Wheat,  corn,  rye,  oats, 
barley,  rice  and  buckwheat  are  in  commonest  use. 

The  natural  grain  is  surrounded  by  an  indigestible  husk 
which  is  always  removed.  Grains  simply  hulled  or  husked, 
and  slightly  crushed  are  called  groats  or  grits;  more  finely 
€rushed,  they  constitute  meal ;  ground  to  a  powder  and  sifted 
they  form  flour. 

Composition.  Cereals  contain  all  the  food  principles,  with 
considerable  cellulose,  especially  in  the  outer  skin,  which  forms 
hran  in  milling.  They  are  comparatively  dry  materials,  hav- 
ing an  average  water  content  of  about  10  per  cent.  The  pro- 
tein content  is  fairly  high,  averaging  12  per  cent. -13  per  cent.^ 
The  fat  is  never  large  in  amount,  ajid  varies  within  wide 
limits,  being  greatest  in  corn  and  oats  and  their  products,  and 
lowest  in  rice. 

The  nutrients  in  largest  proportion  are  the  carbohydrates, 
which  frequently  constitute  75  per  cent,  of  the  whole.  The 
ash  content  is  as  large  as  in  most  common  food  materials,  and 
some  of  the  grains,  as  oats  and  wheat,  are  especially  valuable 
for  their  soluble  phosphates  of  calcium,  potassium,  magne- 
sium, etc. 

The  chemical  composition  of  some  of  the  most  common 
cereals  is  shown  in  the  following  table : 

Carbohydrates 

Water     Protein        Fat     Starch,  etc.  Crude  Fiber  Ash 
Per  Cent.  Per  Cent.  Per  Cent.  Per  Cent.  Per  Cent.  Per  Cent. 

Barley   10.9  12.4  1.8  69.8  2.7  2.4 

Corn   (maize)    ...   9.3  9.9  2.8  74.9  1.4  1.5 

Oats   11.0  11.8  5.0  59.7  9.5  3.0 

Rice   12.4  7.4  0.4  79.2  0.2  0.4 

Wheat  (spring)  ..10.4  12.5  2.2  71.2  1.8  1.9 

It  will  be  seen  that  corn  is  relatively  rich  in  fat;  oats  in 
both  protein  and  fat;  rye  and  wheat  in  protein  with  a  mod- 
erate amount  of  fat;  rice  is  notably  free  from  crude  fiber 
and  fat,  and  also  very  low  in  ash. 

^  For  further  information,  see  "Cereal  Breakfast  Foods,"  Farmer's  Bulle- 
tin No.  249,  Agricultural  Dept.,  Washington,  D.  C. 


CEREALS 


235 


Cereal  Breakfast  Foods  are  very  similar  in  composition  to 
the  grains  from  which  they  are  made. 

Macaroni  is  much  like  wheat  breakfast  foods  in  composition 
and  food  value. 

Principles  in  Cooking,  Cooking  improves  cereals  in  many 
ways.  For  the  average  person^  proper  cooking  has  almost  as 
much  to  do  with  the  nutriment  finally  obtained  as  the  pro- 
portions of  nutrients  originally  present.  Flavor  and  appear- 
ance are  improved^  with  the  gain  in  digestibility  that  comes 
from  appetizing  foods  which  stimulate  the  flow  of  digestive 
juices.  Cooking  to  convert  nutrients  into  more  digestible 
f orms^  is  very  important  in  the  case  of  cereals  which  contain 
so  much  starch;  and  since  the  starch  in  these  foods  is  sur- 
rounded by  cell-walls  of  crude  fiber  (largely  cellulose)  upon 
which  the  digestive  juices  are  unable  to  act^  these  walls  must 
be  broken  down.  Part  of  this  disintegration  may  be  accom- 
plished in  milling,  and  part  by  thorough  mastication  but  com- 
plete digestion  of  the  starch  is  assured  only  by  thorough 
cooking. 

Parching  is  one  of  the  simplest  methods  of  cooking  grains. 
The  invisible  moisture  in  the  cells  is  expanded  by  the  heat, 
and  the  cell  walls  burst.  Some  of  the  starch  is  also  made 
soluble  or  changed  to  dextrin  by  this  process.  The  digestibil- 
ity of  protein  seems  to  be  lessened  by  cooking  at  high  tem- 
peratures, but  the  starch  can  be  made  almost  perfectly  di- 
gestible. 

The  softening  of  cellulose  is  more  perfectly  accomplished 
by  cooking  for  a  long  time  in  the  presence  of  a  large  amount 
of  moisture,  as  in  steaming,  or  cooking  with  water  or  milk 
in  a  double  boiler.  The  glutinous  material  which  surrounds 
the  starch  grains  and  prevents  their  digestion  is  disintegrated 
so  that  the  digestive  juices  can  act.  In  general,  the  more 
crude  fiber  a  cereal  contains,  the  longer  it  should  be  cooked. 
Eeference  to  the  table  (p.  234)  shows  that  oats  requires 
more  cooking  than  rice;  whole  or  partially  crushed  grains 
than  finely  ground  ones.  There  is  danger  in  undercooked 
cereals,  not  only  of  loss  of  valuable  nutriment  through  failure 


236  VEGETABLE  OR  PLANT  FOODS 


of  digestion^  but  in  irritation  of  the  alimentary  tract.  This 
should  be  especially  remembered  in  preparing  partially  cooked 
breakfast  foods. 

When  cereals  are  cooked  in  water  some  of  it  is  absorbed, 
and  soluble  substances  in  the  food  pass  into  the  remaining 
water.  If  this  is  thrown  away^,  as  when  rice  is  boiled  in  a 
large  quantity  of  water  and  subsequently  drained  dry,  a  con- 
siderable part  of  the  nutriment  is  lost.  Eice  water  frequently 
contains  enough  dissolved  starch  to  form  a  jelly  on  cooling. 
Por  this  reason  steaming  is  a  preferable  method.  Practical 
application  of  the  fact  that  certain  nutrients  in  cereals  are 
soluble  is  made  in  the  preparation  of  all  kinds  of  cereal 
waters  and  starchy  jellies.    (See  Recipes,  pp.  124-244.) 

Gruels  are  thin  porridges  made  from  flour  or  other  finely 
ground  grain  products,  with  either  water  or  milk.  They  are 
cooked  for  a  long  time  to  insure  the  starch  being  changed  to 
soluble  starch,  or  even  partially  dextrinized.  Time  for  cook- 
ing should  therefore  be  conscientiously  kept  by  the  clock. 

By  passing  the  material  through  a  cheese-cloth  or  sieve,  the 
coarser,  undissolved  portions  are  removed,  and  the  smooth 
product  does  not  irritate  weakened  digestive  organs;  hence 
this  method  is  desirable  for  invalids  and  young  children. 

In  cooking  all  cereal  products,  the  following  points  should 
be  observed: 

Use  a  double  boiler. 

Observe  carefully  the  correct  proportions  of  cereal,  water 
and  salt. 

Cook  at  boiling  temperature  (212°  P.). 
Watch  the  time  by  the  clock,  and  always  cook  the  full  time 
prescribed,  preferably  longer. 
Serve  attractively. 

Improper  cooking  and  poor  serving  are  largely  responsible 
for  unpopularity  of  cereal  foods. 

Digestibility,  The  digestibility  of  cereals  is  greatly  in- 
fluenced by  the  mode  of  preparation  and  the  thoroughness  of 
insalivation.  Por  the  normal  healthy  person  cereal  foods  are 
very  wholesome.    In  general,  about  90  per  cent,  or  more  of 


CEREALS 


237 


the  organic  matter  is  assimilated.  The  carbohydrates  are 
most  completely  digested ;  the  protein  shows  a  wide  variation, 
but  is  less  perfectly  assimilated  than  the  other  nutrients, 
owing  partly  to  the  fact  that  it  is  often  hardened  in  cooking 
and  partly  that  it  is  intimately  bound  up  with  cellulose  in 
the  bran  coats.  For  this  reason  white  flour  shows  a  higher 
degree  of  digestibility  for  protein,  than  do  whole  wheat  prepa- 
rations. 

Among  cereal  breakfast  foods,  rolled  wheat  ranks  first  in 
digestibility,  rolled  oats  next,  and  corn  preperations  among 
the  lowest.  The  partially  digested  or  ready-to-eat  cereals 
supply  more  digestible  material  than  the  plain  grains  when 
well  cooked. 

Nutritive  Value.  Cereals  supply  actual  digestible  nutri- 
ments to  the  body  more  cheaply  than  any  other  class  of  foods 
except  the  dried  legumes.  All  animal  foods,  especially  meats, 
are  more  expensive,  even  as  sources  of  protein,  than  cereals. 
A  glance  at  their  composition  shows  that  they  are  chiefly  fuel 
foods,  because  of  their  high  carbohydrate  content.  Their 
cost  varies  with  the  cost  of  labor  and  fuel  in  preparing  the 
food.  The  comparatively  expensive  ready-to-eat  breakfast 
foods  do  not  yield  any  extra  nutritive  value.  Their  only  ad- 
vantages are  pleasant  flavor  and  ease  of  serving.  Cereal 
products  yield  on  the  average  between  1600  and  1700  calories 
per  pound.  Thus: 

1  lb.  flour  furnishes  1665  calories. 

1  lb.  entire  wheat  flour  furnishes  1675  calories. 

1  lb.  corn  meal  furnishes  1655  calories. 

1  lb.  cornstarch  furnishes  1675  calories. 

1  lb.  wheatlet  furnishes  1685  calories. 

1  lb.  hominy  furnishes  1650  calories. 

1  lb.  granulated  corn  meal  furnishes  1665  calories, 

1  lb.  wheat  germ  furnishes  1695  calories. 

1  lb.  tapioca  furnishes  1650  calories. 

Care  of  Cereals.  Cereals  must  be  kept  in  a  cool,  dry  place; 
warmth  will  favor  the  development  of  the  maggot  eggs;  and 
moisture,  when  absorbed,  makes  them  musty. 


238  VEGETABLE  OR  PLANT  FOODS 


GRUELS 

ARROWROOT  GRUEL,  205  CALORIES  i 

(Individual  Rule.) 
2  teaspoons  arrowroot.  1  cup  boiling  water  or  milk. 

2  tablespoons  cold  water.  Salt. 

Sugar,  lemon  juice,  wine  or  brandy  as  required. 

Blend  the  arrowroot  and  cold  water  to  a  smooth  paste. 
Add  to  the  boiling  water  or  milk.  Cook  in  double  boiler  two 
hours.    Add  salt.    Strain  and  serve  hot. 

Arrowroot  is  the  purest  form  of  starch,  and  beneficial  in 
case  of  diarrhoea  if  not  given  too  hot. 

BARLEY  GRUEL,  248  CALORIES 

(Individual  Rule.) 

1  tablespoon  barley  flour.  1  cup  scalded  milk. 

2  tablespoons  cold  milk.  Salt. 

Blend  the  barley  flour  with  the  cold  milk  and  stir  into 
the  scalding  milk.  Cook  in  double  boiler  twenty  minutes. 
Season  with  salt  to  taste,  and  add  sugar  if  desired.  Strain. 

BARLEY  GRUEL  OR  JELLY,  142  CALORIES  i 

(Individual  Rule.) 

1  tablespoon  barley  flour.  l^  cup  milk  (if  desired). 

2  tablespoons  cold  water.  Salt. 

1  cup  boiling  water. 

Blend  carefully  the  barley  flour  and  the  cold  water;  add 
gradually  to  the  boiling  water  and  cook  twenty  minutes.  Add 
milk  and  salt  to  taste^  reheat  to  boiling  point,  strain  and 
serve  or  bottle  for  keeping. 

Note. —  For  jelly  omit  the  milk  and  strain. 

RICE  OR  OAT  GRUEL 

Eice  or  oat  gruel  may  be  made  in  same  way  as  Barley 
Gruel  No.  I  or  II,  using  the  prepared  flour  for  the  purpose. 

BARLEY  GRUEL  (WITH  BROTH),  308  CALORIES 

( Two  Servings. ) 

2  cups  beef  broth.  2  tablespoons  cold  water. 
2  tablespoons  barley  flour.  1  saltspoon  salt. 

^  Calculated  with  milk. 


GRUELS 


339 


Mix  barley  flour  and  salt  with  the  cold  water  to  form  a 
smooth  paste.  Add  gradually  to  the  boiling  stock  and  boil 
one-half  hour.    Strain  and  serve  very  hot. 

CRACKER  GRTJEL,  243  CALORIES 

(Individual  Rule.) 
2  tablespoons  sifted  cracker  1  cup  scalded  milk. 

crumbs. 
Ys  teaspoon  salt. 

Pour  hot  milk  gradually  onto  cracker  crumbs,  stirring  con- 
stantly. Cook  in  double  boiler  five  minutes  or  two  minutes 
over  direct  heat. 

Xote. —  Before  preparing  crumbs,  crackers  may  be  baked 
in  a  slow  oven  until  a  delicate  brown;  or  graham  crackers 
may  be  used.  A  convenient  way  to  prepare  the  crumbs  is  to 
put  them  several  times  through  a  meat  chopper  and  then  sift. 

FLOUR  GRTJEL  OR  THICKENED  MILK,  212  CALORIES 

(Individual  Rule.) 
%  cup  scalded  milk.  Speck  salt. 

%  cup  cold  milk.  1  dozen  raisins. 

l^  tablespoon  flour. 

Scald  the  milk.  Mix  the  flour  with  the  cold  milk  to  make 
a  smooth  mixture^  and  stir  into  the  scalding  milk.  Cook  in 
a  double  boiler  one-half  hour  or  on  back  of  stove  in  a  sauce- 
pan. 

Stone  and  quarter  the  raisins^  then  add  water  enough  to 
cover;  cook  slowly  until  water  has  all  boiled  away.  Add  to 
gruel  just  before  serving.  Add  salt.  Strain  and  serve,  or  it 
may  be  eaten  with  the  raisins  in  it. 

Note. —  This  gruel  may  be  made  without  the  raisins. 
Never  use  raisins  in  bowel  troubles. 

FARINA  GRUEL,  102  CALORIES 

(Individual  Rule.) 
%  tablespoon  farina.  %  cup  scalded  milk. 

%  cup  cold  water.  Salt. 
Yz  cup  boiling  water. 


240 


VEGETABLE  OR  PLANT  FOODS 


Mix  the  farina  with  the  cold  water,  add  to  the  boiling 
water  and  boil  thirty  minutes.  Add  the  scalding  milk. 
Taste  and  season  properly.  A  little  sugar  may  be  added  if 
desired,  or  an  egg  may  be  beaten  and  the  gruel  poured  into  it. 

GLUTEN  GRUEL  OR  PORRIDGE  (FOR  THE  DIABETIC),  185  CAL- 
ORIES 1 

(Individual  Rule.) 

%  tablespoon  Gum  Gluten  Flour.  1  cup  hot  water  or  milk. 
1  tablespoon  cold  water.     '  Salt. 

Add  cold  water  slowly  to  Gluten  Flour  to  form  a  thin 
paste,  then  add  gradually  to  boiling  water,  while  stirring  con- 
stantly; cook  fifteen  minutes.  Season  with  salt.  Is  an  ex- 
cellent food  for  the  sick ;  for  baby  food  it  may  be  sweetened. 

INDIAN  MEAL  GRUEL,  48  CALORIES  2 

1  tablespoon  Indian  meal.  2  tablespoons  cold  water. 
14  tablespoon  flour.                      2  cups  boiling  water. 

%  teaspoon  salt.  Milk  or  cream. 

Blend  the  meal^  flour  and  salt  with  the  cold  water  to  make 
a  smooth  paste^  and  stir  into  the  boiling  water.  Boil  gently 
one  hour  and  a  half.  Dilute  with  hot  water,  milk  or  cream. 
Strain. 

OATMEAL  GRUEL  NO.  I,  70  CALORIES  2 

%  cup  coarse  oatmeal.  I14  cup  boiling  water, 

teaspoon  salt.  Milk  or  cream. 

Add  oatmeal  and  salt  to  the  boiling  water,  and  cook  four  to 
five  hours  in  a  double  boiler,  adding  more  water  if  necessary. 
Strain  and  dilute  with  hot  milk  to  make  it  of  the  right  con- 
sistency.   Eeheat  and  serve. 

Note. —  Sugar,  and  a  little  port  wine  may  be  added  if  al- 
lowed and  desired. 

^  Calculated  with  milk. 

2  Without  milk  or  cream.  . 


GRUELS 


241 


OATMEAL  GRUEL,  NO.  II,  70  CALORIES  i 

l^  cup  rolled  oats.  l^  teaspoon  salt. 

11/3  cup  boiling  water.  Milk  or  cream. 

Mix  the  oats,  water  and  salt  in  top  of  double  boiler.  Cook 
over  direct  heat  five  minutes  and  then  over  hot  water  one 
hour.  Strain,  bring  to  the  boiling  point  and  add  milk  or 
cream  as  desired. 

OATMEAL  GRTJEL  NO.  Ill,  140  CALORIES  1 

%  cup  coarse  oatmeal.  Salt. 
2  cups  water.  Milk. 

Pound  the  oatmeal  in  a  mortar  until  it  is  mealy,  then  put 
it  into  a  tumbler  and  fill  it  with  cold  water.  Stir,  and  pour 
off  the  mealy  water  into  a  saucepan.  Fill  tumbler  again,  stir 
and  pour  off,  and  repeat  until  the  above  quantity  of  water  is 
exhausted.  Boil  the  oatmeal  water  thirty  minutes,  stirring 
frequently.  Season  with  salt  to  taste.  Thin  with  milk  or 
cream  to  desired  consistency. 

EGG  AND  SHERRY  GRUEL,  388  CALORIES 

(Individual  Rule.) 
1  egg.  1  tablespoon  sugar. 

1  wineglass  sherry.  Grating  of  nutmeg. 

1  teaspoon  lemon  juice.  1  cup  smooth  hot  gruel. 

Beat  the  egg;  add  wine,  lemon,  nutmeg  and  pour  on  the 
hot  gruel. 

CAUDLE,  404  CALORIES  2 

l^  cup  Scotch  oatmeal.  Juice  l^  lemon. 

2  quarts  water.  Sugar,  cinnamon,  brandy,  or 
Salt  to  taste.  wine. 

^  cup  raisins. 

Boil  oatmeal,  water  and  salt  four  or  five  hours.  Strain; 
if  too  thick  add  a  little  hot  water  and  whip  it  with  a  wooden 
spoon.  Eemove  seeds  from  raisins,  cook  a  short  time  in  hot 
water,  and  add  raisins  and  water  to  above.  Add  lemon  juice, 
and  sugar,  cinnamon,  brandy  or  wine  to  taste. 

^  Without  milk  or  cream. 
2  Without  sugar  or  liquor. 


242  VEGETABLE  OR  PLANT  FOODS 


FLOUR  BALL  OR  BOILED  OR  BROWNED  FLOUR  GRUEL  (FOR 
TEETHING  CHILDREN) 

Tie  one  cup  of  wheat  flour  in  a  thick  cloth,  and  boil  it  in 
one  quart  of  water  for  three  hours ;  remove  the  cloth  and  ex- 
pose the  flour  to  the  air,  or  heat  until  it  is  hard.  Grate  from 
it  when  wanted.  Put  one  tablespoonful  into  half  a  pint  of 
new  milk,  and  stir  over  the  fire  until  it  comes  to  a  boil;  add 
a  pinch  of  salt  and  a  tablespoon  of  cold  water,  and  serve. 
This  gruel  is  excellent  for  children  afflicted  with  summer  com- 
plaint. Or  brown  a  tablespoon  of  flour  in  the  oven,  or  on 
top  of  the  stove  in  a  baking  tin ;  feed  a  few  pinches  at  a  time 
to  a  child,  and  it  will  often  check  diarrhoea. 

BREAKFAST  FOODS 

Fruits  served  with  breakfast  foods  make  them  more  ap- 
petizing. 

Follow  directions  on  package  for  preparing  patent  or  pre- 
pared^cereals,  allowing  double  the  given  time  for  cooking. 

HASTY  PUDDING  OR  CORNMEAL  MUSH,  182  CALORIES  i 

(Individual  Rule.) 
14  cup  cornmeal.  %  cup  cold  milk  or  water. 

l^  tablespoon  flour.  %  cup  boiling  water. 

%  teaspoon  salt. 

Mix  the  meal,  flour  and  salt  with  the  cold  milk  or  water; 
when  smooth,  stir  into  the  boiling  water.  Cook  in  a  double 
boiler  one  hour  or  more;  or  over  direct  heat  one-half  hour. 
Serve  with  cream  and  sugar,  turn  into  tins  to  cool  if  wanted 
for  sauteing.  Cut  into  slices,  dip  in  flour  and  saute  in  drip- 
pings or  butter. 

GLUTEN  BREAKFAST  FOOD   (FOR  THE  DIABETIC),  665  CAL- 
ORIES 

(Two  Servings.) 
%  cup  Gum  Gluten  Breakfast  2  cups  cold  water. 
Food.  Salt. 

Would  suggest  partly  cooking  the  Breakfast  Food  the  day 

^  Calculated  with  milk. 


BREAKFAST  FOODS 


24S 


before  using^  as  a  long  cooking  improves  the  quality.  Put 
the  food  in  the  water  and  cook  over  direct  heat  for  fifteen 
minutes^,  then  put  in  double  boiler  and  cook  for  about  one 
hour^  adding  salt  to  taste  when  nearly  done.  It  is  then  neces- 
sary to  cook  it  but  twenty  minutes  in  the  morning.  Serve 
with  cream. 

HOMINY  MUSH,  200  CALORIES 

(Individual  Rule.) 
^  cup  fine  hominy.  ll^  cups  boiling  water. 

^  teaspoon  salt. 

Put  all  together  in  a  double  boiler  and  cook  two  hours 
Add  more  water  if  mush  seems  stiff  and  thick;  all  prepara- 
tions of  corn  absorb  a  great  deal  of  water  in  cookings  and 
hominy  usually  needs  a  little  more  than  four  times  its  bulk. 

Note. —  Hominy  is  exceedingly  indigestible  unless  well 
cooked^  but  sweet  and  nutritious  when  subjected  to  a  high 
temperature  for  a  long  time. 

OATMEAL  MUSH  FOR  CHILDREN  AND  INVALIDS,  880  CALORIES 

(Four  Servings.) 
1  cup  granulated  oatmeal.  1  scant  quart  boiling  water. 

1  teaspoon  salt. 

Put  the  oatmeal  and  salt  in  a  double  boiler^  pour  on  the 
boiling  water  and  cook  three  or  four  hours.  Eemove  the 
cover  just  before  serving^  and  stir  with  a  fork  to  let  the 
steam  escape.  If  the  water  in  the  lower  boiler  be  strongly 
salted,  the  oatmeal  will  cook  more  quickly.  Serve  with  sugar 
or  salt  and  cream  or  milk. 

Note. —  Baked  sour  apples,  apple  sauce  and  apple  jelly  are 
delicious  eaten  with  oatmeal.  They  should  be  served  with  the 
mush,  and  sugar  and  cream  poured  over  the  whole.  They 
give  the  acid  flavor  which  so  many  crave  in  the  morning. 
Coarse  oatmeal  is  not  advisable  in  any  form  of  water  brash, 
acidity  or  bowel  irritations.  It  often  causes  eruptions  on  the 
skin  in  warm  weather. 

BOILED  RICE 

See  "  Eice  Puddings    for  recipe.    Page  397. 


344  VEGETABLE  OR  PLANT  FOODS 


STEAMED  RICE 

See Eice  Puddings    for  recipe.    Page  298. 

STARCHY  JELLIES 

BARLEY  JELLY,  270  CALORIES 

(Three  Servings.) 

3  tablespoons  pearl  barlej.  l^  saltspoon  salt. 
1  quart  cold  water. 

Soak  barley  over  nighty  drain  and  add  the  quart  of  fresh 
water;  add  salt;  and  cook  in  double  boiler  steadily  for  four 
hours  down  to  one  pint,  adding  water  from  time  to  time; 
strain  through  muslin.  When  cold  this  makes  a  thick  jelly. 
Two  tablespoons  dissolved  in  eight  ounces  of  warmed  and 
sweetened  milk  may  be  given  at  single  feeding  for  infants. 

Note. —  Oatmeal  wheaten  grits  and  rice  grains  may  be  used 
in  same  way. 

Jelly  made  with  Barley  Flour,  see  Barley  Gruel,  p.  338. 

RICE  JELLY,  181  CALORIES 

(Three  Servings.) 
tablespoons  rice.  %  cup  milk. 

1  cup  cold  water.  1  white  of  egg. 

Speck  salt. 

Wash  the  rice  and  soak  in  cold  water  two  hours,  drain  off 
the  water  and  add  the  milk,  cook  in  double  boiler  one  and  one- 
half  hours.  Strain  through  a  fine  sieve.  Pour  into  molds, 
chill  and  serve  with  fruit  juice  or  cream  and  sugar. 

TAPIOCA  JELLY,  200  CALORIES 

(Three  Servings.) 

4  tablespoons  pearl  tapioca.  %  cup  boiling  water. 
1  cup  cold  water.                        Speck  salt. 

Soak  tapioca  in  cold  water  three  hours;  add  boiling 
water  and  salt;  cook  in  double  boiler  two  and  one-fourth 
hours.  Serve  hot,  plain  with  cream,  wine  and  powdered 
sugar,  or  flavor  while  hot  with  lemon  juice,  and  chill. 

CORNSTARCH  JELLIES 

See    Cornstarch  Pudding for  recipe.    Page  295. 


MACARONI 


245 


MACARONI 

BOILED  MACARONI,  98  CALORIES  i 

(Individual  Rule.) 
14  cup  macaroni.  1  teaspoon  salt. 

3  cups  boiling  water.  Cream  or  milk. 

Break  macaroni  into  one-inch  pieces^  put  into  a  strainer 
and  rinse  with  cold  water.  Cook  in  boiling  salted  water 
twenty  minutes,  or  until  tender.  Strain^  pour  a  little  cold 
water  over  it  to  prevent  pieces  from  adhering;  add  cream^ 
reheat  and  season  with  salt;  or  serve  with  White  or  Tomato 
Sauce  and  grated  cheese. 

WHITE  SAUCE,  152  CALORIES 

(Individual  Rule.) 
l^  cup  milk.  14  tablespoon  flour. 

1/2  tablespoon  butter.  ^4  teaspoon  salt. 

Scald  the  milk.  Melt  the  butter,  remove  from  stove  and 
add  the  flour  and  mix  thoroughly,  then  pour  on  gradually  the 
hot  milk,  stirring  constantly  while  blending.  Cook  thor- 
oughly until  there  is  no  raw  taste  of  starch  and  season  with 
salt. 

TOMATO  SAUCE,  93  CALORIES 

(Individual  Rule.) 
1/3  cup  strained  tomato  juice.      %  tablespoon  flour. 
l^  tablespoon  butter.  Salt  and  pepper  to  taste. 

Scald  the  tomatoes.  Melt  the  butter  and  remove  from 
stove,  add  the  flour  and  mix  thoroughly,  then  pour  on  grad- 
ually the  hot  tomato,  stirring  constantly  while  blending ;  cook 
thoroughly  until  there  is  no  raw  taste  of  starch  and  season 
with  salt  and  pepper. 

BAKED  MACARONI 

1  tablespoon  grated  fresh  cheese  =  62  Calories. 
Fill  a  buttered  baking-dish  with  alternate  layers  of  maca- 
roni. White  Sauce  and  cheese;  then  cover  with  buttered 

1  Without  milk  or  cream. 


346  VEGETABLE  OB  PLANT  FOODS 


cracker  crumbs  and  bake  until  crumbs  are  a  golden  brown. 
Tomato  Sauce  may  be  substituted  for  White  Sauce  if  desired. 

BUTTERED  CRACKER  CRUMBS,  201  CALORIES 

1  tablespoon  butter.  ^  cup  cracker  crumbs. 

Melt  butter  and  add  cracker  crumbs  that  have  been  rolled 
fine.  To  be  used  for  the  top  of  any  scalloped  dish.  Cracker 
crumbs  or  bread  crumbs  may  be  used  and  bits  of  butter  dotted 
over  top. 

NOODLES  (FOR  THE  DIABETIC),  596  CALORIES 

(Individual  Rule.) 
1  egg,  well  beaten.  5  ounces  Gum  Gluten  Flour. 

1  tablespoon  milk. 

Beat  egg^  add  milk  and  gradually  add  the  Gluten  Flour. 
Koll  out  and  cut  in  thin  strips.    Serve  with  any  soup. 

BOILED  NOODLES  (FOR  THE  DIABETIC) 

Put  the  noodles  into  cold,  salted  water ;  cook  at  least  forty- 
five  minutes  after  it  comes  to  boil,  or  boil  until  it  is  tender. 
Season  with  pepper  and  butter.    Serve  with  White  Sauce. 

CREAM  OR  WHITE  SATJCE  (FOR  THE  DIABETIC),  130  CALORIES 

(Individual  Rule.) 
%  cup  milk.  1  teaspoon  Gum  Gluten  Flour. 

1  teaspoon  butter. 

Melt  the  butter  without  browning  it,  add  the  flour,  then 
pour  in  the  scalded  milk  gradually,  stirring  all  the  time. 
Cook  five  minutes.  Season  with  salt  and  red  pepper  to  taste. 
Flavor  with  onion,  lemon  juice  or  parsley  if  desired.  Pour 
over  vegetables  very  hot. 

NOODLES  ATI  GRATIN  (FOR  THE  DIABETIC) 

1  tablespoon  grated  fresh  cheese  =■  62  Calories. 
^  Boil  the  noodles  as  above.  Place  them  in  a  baking-dish  in 
alternate  layers  with  grated  cheese,  having  cheese  form  the 
top  layer;  season  with  pepper  and  butter.  Pour  over  the 
mixture  the  water  in  which  the  noodles  were  cooked;  or,  if 
preferred,  cream  or  stewed  tomatoes  may  be  used  to  moisten. 


BREAD 


247 


BREAD 

From  the  most  remote  times,  bread  has  been  an  important 
part  of  the  diet  of  mankind.  It  is  to-day  probably  more  gen- 
erally and  extensively  used  than  any  other  one  food-stuff, 
with  the  possible  exception  of  milk.  It  is  therefore  extremely 
important  to  know  what  constitutes  good  bread  and  what  are 
its  nutritive  properties. 

Composition.  The  ingredients  of  bread  are  very  simple  — 
flour,  water,  yeast  and  salt.  Any  cereal,  cleaned,  crushed  and 
sifted  to  a  powder,  may  serve  as  the  flour,  but  wheat  flour 
makes  the  most  satisfactory  bread,  because  its  proteins  in 
the  form  of  gluten  have  more  elasticity  than  those  of  other 
cereals. 

"  Bread  contains  from  34  to  40  per  cent,  of  water,  and  the 
remainder,  about  60  per  cent,  at  least,  is  nutritive  material. 
It  contains  a  large  amount  of  carbohydrates,  a  moderate 
amount  of  protein,  a  small  amount  of  mineral  matter,  and 
almost  no  fat.  Owing  to  the  excess  of  carbohydrates  and 
deficiency  of  protein  in  wheat,  bread  could  not  serve  alone 
for  the  proper  nutritive  of  the  body,  because  an  amount  of 
bread  sufficient  to  supply  the  requisite  protein  would  furnish 
much  more  carbohydrates  than  necessary.  In  a  mixed  diet 
this  discrepancy  is  of  little  importance,  as  it  is  supplied  by 
the  other  protein  foods  eaten.  Most  methods  of  increasing 
the  protein  contents  of  bread  have  a  tendency  to  increase 
the  cost,  but  skim  milk  can  be  used  in  place  of  water  in  the 
mixing  with  little  added  expense,  and  it  will  add  about  % 
per  cent,  increase  as  to  protein.^^  ^ 

Digestibility  and  Nutritive  Value.  "The  nutritive  value 
of  bread  depends,  not  only  on  its  chemical  composition,  but 
also  on  its  digestibility,  and  digestibility  in  its  turn  seems 
to  depend  largely  on  the  lightness  of  the  loaf.  It  is  the 
gluten  in  a  dough  which  gives  it  the  power  of  stretching 
and  rising  as  the  gas  from  the  yeast  expands  within  it,  and 


^  From  Farmer's  Bulletin  No.  389,  U.  S.  Dept.  of  Agriculture,  Washinj 
ton,  D.  C.  For  further  information,  read  ' '  Bread  and  Bread-Making, 
Farmer's  Bulletin  No.  389. 


^48  VEGETABLE  OR  PLANT  FOODS 


hence  of  making  a  light  loaf.  Eye  has  less  gluten  proteids 
than  wheats  while  barley^  oats  and  maize  have  none,  so  that 
they  do  not  make  a  light,  porous  loaf  like  wheat.  It  is  pos- 
sible that  of  the  various  kinds  of  wheat  flour  those  con- 
taining a  large  part  of  the  bran  —  entire  wheat  and  graham 
flours  —  furnish  the  body  with  more  mineral  matter  than 
fine  white  flour;  but  it  is  not  certain  that  the  extra  amount 
of  mineral  matter  furnished  is  of  the  same  value  as  that  from 
the  interior  of  the  grain.  They  do  not  yield  more  digestible 
protein  than  the  white  flours,  as  was  for  a  time  supposed. 
It  seems  safe  to  say  that,  as  far  as  is  known,  for  a  given 
amount  of  money^  white  flour  yields  the  most  actual  nourish- 
ment with  the  various  food  ingredients  in  good  proportion. 

^'  It  should  be  remembered,  however,  that  all  kinds  of  bread 
are  wholesome  if  of  good  quality,  and  the  use  of  several 
kinds  is  an  easy  means  of  securing  variety  in  the  diet.^^  ^  As 
compared  with  most  meats  and  vegetables,  bread  has  prac- 
tically no  waste,  and  is  very  completely  digested.  Few  foods 
yield  so  much  energy  for  so  little  money.  A  diet  of  bread 
and  milk  can  be  perfectly  balanced  and  will  be  tired  of  less 
•easily  than  any  other  equally  simple  diet. 

All  bread-stuffs  should  be  eaten  slowly  and  thoroughly 
masticated,  in  order  that  time  may  be  given  for  the  saliva 
to  act  upon  the  starch.  For  if  the  stomach  is  hampered  with 
quantities  of  unchanged  starch  it  cannot  perform  its  work 
without  effort.  Fermentation  results  or  the  intestines  have 
more  than  their  share  of  work  to  do  and  rebel.  If  these  foods 
were  eaten  slowly  much  of  the  resultant  dyspepsia  would  be 
avoided. 

Gluten  Bread.  When,  for  any  reason,  persons  are  denied 
starch  in  the  diet,  as  in  diabetes,  they  find  it  a  great  priva- 
tion to  do  without  bread,  and  many  attempts  have  been  made 
to  provide  an  acceptable  substitute.  Sometimes  bran  is  used, 
or  inulin  or  Iceland  moss,  but  none  of  these  is  nutritious. 
One  of  the  best  materials  for  this  purpose  is  gluten  flour. 

^  From  Farmer's  Bulletin  No.  389,  U.  S.  Dept.  of  Agriculture,  Washing- 
ton, D.  C. 


BREAD 


249 


It  is  prepared  by  washing  the  starch,  wholly  or  in  part,  from 
wheat  flour.  The  grayish,  tough,  elastic,  sticky  mass  left 
after  this  process  is  largely  gluten,  and  since  gluten  is  a 
protein,  it  has  been  sometimes  called  "  the  lean  meat  of  the 
vegetable  kingdom/^  The  washed  gluten,  dried  and  ground^ 
is  called  gluten  flour. 

It  still  contains  considerable  starch,  so  that  it  is  necessary 
for  the  physician  to  know  the  exact  composition  of  the  brand 
employed,  to  insure  good  results. 

Gluten  Standards.  The  necessity  for  a  Standard  for  Gluten 
Flour  is  very  apparent  to  chemists  who  have  had  occasion  to 
analyze  the  various  kinds  on  the  market.  For  years  millers 
have  supplied  dealers  with  middlings,  entire  wheat  flour  and 
mixtures  containing  bran  to  be  sold  as  gluten  flour.  Igno- 
rant of  those  facts,  physicians  advise  their  patients  to  use 
gluten,  but,  of  course,  have  invariably  been  disappointed  in 
results. 

United  States  Standard  for  Gluten: 

"  Gluten  Flour  is  the  product  made  from  flour  by  the  re- 
moval of  starch,  and  contains  not  less  than  five  and  six- 
tenths  (5.6)  per  cent,  of  Nitrogen,  and  not  more  than  ten 
(10)  per  cent,  of  Moisture.^^ 

Note. —  Using  the  factor  6.25  usually  employed  by  the  U* 
S.  Government  chemists.  Standard  Gluten  Flour  must  there- 
fore show  at  least  thirty-five  (35)  per  cent,  protein. 

Bread-MaJcing,  The  two  practical  methods  of  making* 
bread  are  with  yeast  (fermented  bread)  and  with  cream  of 
tartar  and  bicarbonate  of  soda  (unfermented  bread). 

Fermented  Bread,  The  raising  or  leavening  of  bread  is 
usually  brought  about  by  allowing  yeast  to  develop  in  it. 
Yeast  is  an  exceedingly  minute  form  of  plant  life,  which, 
when  given  food,  flour,  moisture  and  warmth,  grows;  and 
by  this  growth  produces  carbon  dioxide  and  alcohol. 

The  carbon  dioxide,  in  its  effort  to  escape,  puffs  up  the 
flour  dough,  but  owing  to  the  viscous  nature  of  the  gluten 
(the  elastic,  strength-giving  substances  of  flour)  it  is  caught 
and  retained. 


250  VEGETABLE  OR  PLANT  FOODS 


Each  little  bubble  of  gas  occupies  a  certain  space,  and 
when  the  bread  is  baked  the  walls  around  these  spaces  harden 
and  tlie  result  is  a  porous  loaf.  The  alcohol  escapes  into  the 
oven  in  the  baking. 

To  bake  bread  requires  a  hot  oven. 

The  bread  should  continue  to  rise  for  about  fifteen  min- 
utes after  being  placed  in  the  oven^  then  the  rising  should 
cease  and  the  loaf  begin  to  brown. 

We  bake  bread  to  kill  the  yeast  plant,  to  render  the  starch 
soluble,  to  expel  the  alcohol  and  carbon  dioxide  and  to  form 
a  nice  flavored  crust. 

The  making  of  good  bread  requires  care  and  intelligence 
on  the  part  of  the  cook.  Use  a  good  brand  of  flour,  fresh 
yeast,  remembering  that  yeast  is  a  plant  and  must  be  put  at 
a  proper  temperature  to  grow.    Watch  each  process  carefully. 

"  Lightness  and  sweetness  of  bread  depends  as  much  on 
the  way  in  which  it  is  made  as  on  the  materials  used.  The 
greatest  care  should  be  used  in  preparing  and  baking  the 
dough  and  in  cooking  and  keeping  the  finished  bread.^^ 

Unfermented  Bread,  Carbon  dioxide  is  obtained  to  lighten 
bread  by  causing  cream  of  tartar  and  bicarbonate  of  soda  to 
unite  chemically. 

To  one  part  soda  use  two  parts  cream  of  tartar.  When 
given  moisture  and  heat  carbon  dioxide  is  obtained. 

Baking  powder  is  a  combination  of  the  following  in- 
gredients : 

Bicarbonate  of  soda   84  grammes  to 

Cream  of  tartar   188  grammes 

Starch   5  to  20  per  cent. 

WHITE  FLOUR  BREAD 

1  slice  (1  oz.)  =73  Calories. 
1  pint  hot  milk  (or  water).  1  tablespoon  salt. 

1  pint  cold  milk  (or  water).         1  Fleischmann's  yeast  cake. 

1  tablespoon  sugar.  Flour  (about  3  quarts). 

2  tablespoons  butter  or  lard. 

Into  mixing  bowl  put  the  scalded  milk^,  add  the  butter; 
when  melted  add  the  sugar,  salt  and  cold  milk.    Save  one- 


BREAD 


251 


half  cup  of  this  liquid^  and  when  lukewarm  soften  the  yeast 
in  it  and  stand  where  it  will  keep  warm.  To  above  mixture 
add  warmed  sifted  flour  (sift  twice  before  using)  to  make  a 
thin  batter^  add  softened  yeast  and  more  flour  until  stiff 
enough  to  knead.  Knead  until  light  and  spongy.  Care 
should  be  taken  not  to  add  more  flour  than  is  absolutely  neces- 
sary. Butter  a  large  stone  crock  or  bowl,  place  bread  in  it 
and  cover.  Let  rise  three  and  one-half  hours  at  about  75 
degrees  Fahrenheit  (in  a  medium  warm  room).  Then  re- 
move from  jar  and  knead  about  twenty  minutes  until  smooth 
and  velvety,  put  into  pans,  cover  carefully  and  let  rise  one 
hour  or  until  double  its  bulk. 

Bake  in  a  hot  oven  from  forty-five  minutes  to  one  hour, 
depending  upon  size  of  loaves. 

If  hard  crust  is  desired,  remove  from  pans  and  cool  in  a 
draft  of  air.  For  soft  crust,  before  bread  cools  roll  it  in  a 
clean  cloth. 

This  quantity  will  make  three  good  sized  loaves;  one-half 
the  amount  may  be  used  for  one  large  loaf. 

ENTIRE  WHEAT  BREAD 

1  slice  (1  oz.)  =:70  Calories. 

2  cups  scalded  milk.  2  yeast  cakes  dissolved  in  i/^  cup 

2  cups  boiling  water.  lukewarm  water. 

3  tablespoons  butter.  2  cups  white  flour. 

3  tablespoons  salt.  Entire   wheat   flour   enough  to 

5  tablespoons  molasses.  knead. 

Make  as  for  wheat  flour  bread^  and  add  molasses  after  the 
first  rising. 

One-half  of  recipe  may  be  used. 

WHOLE  WHEAT  OR  GRAHAM  BREAD 

Make  the  same  as  wheat  flour  breads  adding  two  table- 
spoons of  sugar  or  molasses.  Make  a  batter  with  white  flour, 
using  three  or  four  cups,  then  use  whole  wheat  or  graham 
flour.  Let  rise  longer  than  for  white  bread,  and  put  imme- 
diately into  pans  without  second  kneading. 

Note. —  Omit  sweetening  if  desired. 


253  VEGETABLE  OR  PLANT  FOODS 


GLUTEN  BREAD  (FOR  THE  DIABETIC) 

1  slice  (1  oz.)  =71  Calories. 
%  yeast  cake.  SVi  cups  Gum  Gluten  Flour. 

2  cups  lukewarm  water.  l^  teaspoon  salt. 

Soften  the  yeast  in  a  small  portion  of  the  water  and  add 
to  the  ingredients.  Mix  to  a  stiff  dough  and  knead  thor- 
oughly^ using  more  gluten  if  necessary  to  keep  it  from  stick- 
ing to  the  board.  Shape  into  a  loaf,  place  in  a  buttered  pan 
for  about  two  and  one-half  hours  to  rise  until  the  dough  is 
about  twice  its  bulk.  Then  "bake  for  forty-five  minutes.  If 
desired  the  dough  may  be  given  a  second  mixing  after  the 
first  rising,  letting  it  rise  again  before  baking. 

Note. —  Gum  Gluten  Bread  may  be  made  the  same  as  ordi- 
nary wheat  fiour  bread  with  the  exception  of  shortening, 
which  is  not  required. 

Avoid  having  the  water  too  warm  or  the  bread  will  be 
sticky ;  the  chill  taken  off  is  all  that  is  necessary. 

If  desired,  one  cup  of  nut  meats  cut  in  small  pieces  may  be 
added  to  dough  just  before  putting  into  pans. 

BRAN  BREAD 

Follow  rule  for  Gluten  Bread,  using  one  part  of  bran 
to  four  parts  of  Gluten  Flour  with  one  cup  of  moisture.  If 
the  bran  is  increased  the  moisture  must  be  lessened. 

BOSTON  BROWN  BREAD,  2530  CALORIES 

1  small  slice  ( 1  oz. )  =  64  Calories. 
1  cup  granulated  Indian  meal.      2  cups  sour  milk. 
1  cup  rye  flour.  2  teaspoons  soda. 

1  cup  graham  flour.  %  cup  molasses. 

1  teaspoon  salt. 

Mix  dry  ingredients  (except  soda)  together;  dissolve  soda 
in  sour  milk  and  add,  then,  molasses.  Pour  into  buttered  tins 
and  steam  three  or  four  hours. 

GLUTEN  BISCUIT  (FOR  THE  DIABETIC),  950  CALORIES  i 

1  cup  Gum  Gluten  Self-raising.     1  saltspoon  salt. 
1  tablespoon  butter.  Milk  or  water. 

1  Without  milk. 


BREAD 


253 


Mix  and  sift  dry  ingredients^  rub  in  the  butter,  add  milk 
or  water  to  make  a  soft  dough.  Eoll  and  cut  with  biscuit 
cutter.    Makes  two  large  biscuits. 

GLUTEN  DROP  BISCUIT  (FOR  THE  DIABETIC),  562  CALORIES  i 

1  cup  Gum  Gluten  Flour.  %  teaspoon  baking  powder. 

1  teaspoon  butter.  Milk  or  water. 

^  teaspoon  salt. 

Mix  and  sift  dry  ingredients,  rub  in  the  butter,  add  milk 
or  water  to  make  a  stiff  batter.  Drop  from  spoon  into  a 
buttered  pan,  and  bake  very  quickly.    Makes  three. 

BRAN  BISCUIT,  416  CALORIES  i 

1/2  cup  w^heat  bran.  1  teaspoon  melted  butter. 

14  cup  improved  graham  flour.      1  saltspoon  salt, 
1  teaspoon  Rumford  baking  pow-  Milk, 
der. 

Sift  dry  ingredients,  rub  in  the  butter  and  add  milk  to 
make  a  soft  dough.    Eoll  it  out  and  bake  in  hot  oven. 

BAKING  POWDER  BISCUIT,  694  CALORIES 

1  cup  flour.  1  tablespoon  butter  or  beef  drip- 

2  teaspoons    Rumford    baking  ping. 

powder.  i/^  cup  (scant)  milk  or  water. 

l^  teaspoon  salt. 

Sift  dry  ingredients  twice,  rub  in  the  butter  with  tips  of 
fingers;  using  knife,  stir  in  gradually  the  liquid;  mix  as 
soft  as  can  be  handled;  put  dough  on  a  well-floured  board, 
pat  lightly  to  one  inch  thickness,  cut  with  biscuit  cutter, 
put  on  a  shallow  buttered  tin,  heated,  and  bake  in  a  hot  oven. 
Put  a  little  milk  on  top  of  each  biscuit  before  baking  to 
make  them  brown  well. 

Note. —  Dough  may  be  lightly  kneaded  as  for  bread,  and 
then  cut. 

GLUTEN  MUFFINS  (FOR  THE  DIABETIC),  755  CALORIES 

1  cup  Gum  Gluten  Self-raising.     %  teaspoon  salt. 
1  cup  milk,  or  part  water.  1  egg. 

^Without  milk. 


354  VEGETABLE  OR  PLANT  FOODS 


Beat  egg  and  add  the  milk.  Sift  the  Gluten  and  salt  and 
gradually  add  the  liquid  and  beat  thoroughly.  Bake  in  hot 
buttered  gem  pans. 

BEAN  MUFFINS,  1850  CALORIES 

2  cups  bran.  ^4  cup  butter. 

1  cup  flour.  3  tablespoons  molasses. 

1  teaspoon  soda.  ll^  cups  sour  milk. 

Mix  dry  ingredients^  rub  in  the  butter  with  the  tips  of  the 
fingers^  add  molasses  and  sdur  milk^,  put  into  hot  muffin  tins 
and  bake  in  a  hot  oven. 

WHITE  GEMS,  1627  CALORIES 

2  cups  flour.  2  tablespoons  butter. 
1  teaspoon  salt.  2  tablespoons  sugar. 
4    teaspoons    Rumford    baking  2  eggs. 

powder.  1  cup  milk. 

Sift  dry  ingredients  into  mixing  bowl^  add  melted  butter 
and  rub  it  in  with  tips  of  fingers.  Add  the  well-beaten  eggs 
and  the  milk  gradually  and  beat  all  well  together.  Have 
gem  pans  well  greased  and  heated;  fill  two-thirds  full  and 
bake  in  a  very  hot  oven  fifteen  or  twenty  minutes.  Put  a 
little  melted  butter  on  each  gem  before  putting  it  into  the 
oven.  They  are  sufficiently  cooked  when  tested  with  a  fine 
washed  knitting  needle  and  it  comes  out  dry. 

CORNMEAL  GEMS,  1370  CALORIES 

1  cup  flour.  %  teaspoon  salt. 

%  cup  cornmeal.  1  egg. 

1/3  cup  sugar.  1  cup  milk. 

4    teaspoons    Rumford    baking  1  tablespoon  melted  butter, 
powder. 

Sift  dry  ingredients  into  mixing  bowl^  add  the  milk  and 
well-beaten  egg  and  the  melted  butter.  Put  into  well-greased 
hot  gems  and  cook  in  a  quick  oven. 

POP-OVERS,  730  CALORIES 

1  egg.  Speck  salt. 

1  cup  milk.  1  cup  flour. 


TOAST 


255 


Beat  egg  until  very  lights  add  milk  and  salt  and  sift  in  the 
flour  very  carefully  —  beat  very  light^  never  stirring.  Have 
ready  gem  pans  or  stone  custard  cups^  well  greased  and  heated. 
Pour  in  mixture^  filling  two-thirds  fuU^  and  bake  in  quick 
oven.  This  will  make  six  large  pop-overs.  The  success  of 
these  pop-overs  lies  in  beating  the  batter  well  and  in  having 
the  cups  very  hot  before  putting  in  the  mixture. 

Note. —  These  cannot  be  cooked  successfully  in  tin. 

BUTTER  BALLS 

1  teaspoon  butter  =  36  Calories. 

Cut  butter  in  small  pieces  size  of  balls  desired,  and  put 
in  ice-water.  Soak  the  butter  paddles  in  boiling  water  ten 
minutes,  then  chill  in  ice-water.  Hold  a  paddle  firmly  in 
the  left  hand  and  roll  each  piece  of  butter  with  the  right 
paddle  until  round.  If  butter  sticks  it  must  be  chilled  longer, 
or  paddles  must  be  rubbed  with  salt  and  reheated. 

One  pound  of  butter  will  make  about  thirty  balls. 

TOAST 

In  ordinary  wheat  bread,  starch  is  the  principal  constituent. 
Starch  when  subjected  to  a  high  degree  of  heat  is  changed 
into  an  easily  digested  substance  called  dextrin. 

In  the  ordinary  cooking  of  a  loaf  of  bread  the  starch,  in 
the  outer  layer  is  changed  into  dextrin,  which  gives  the  crust 
its  sweet  flavor.  Slices  of  bread  toasted  undergo  a  similar 
change. 

Bread  is  toasted  not  merely  to  brown  it,  but  to  take  out 
all  the  moisture  possible,  so  that  it  may  be  more  thoroughly 
moistened  with  the  saliva,  and  thus  easily  digested;  also 
to  give  it  a  better  flavor.  The  correct  way  to  make  toast  is 
to  use  stale  bread  cut  in  uniform  slices,  and  to  dry  it  thor- 
oughly before  browning. 

Toast  prepared  in  this  way,  even  if  moistened  with  milk 
or  water,  may  be  easily  and  thoroughly  acted  upon  by  the 
digestive  fluids. 


256  VEGETABLE  OR  PLANT  FOODS 


ENERGY  VALUE  OF  BREAD 

1  slice  (1  oz. )  white  bread  =73  Calories. 

1  slice  (1  oz.)  entire  wheat  bread  70  Calories. 

1  slice  (1  oz. )  gluten  bread  —71  Calories. 

1  small  slice  (1  oz.)  Boston  Brown  Bread..  =64  Calories. 

See  Table^  page  64^  for  energy  value  of  other  ingredients. 
SIPPETS 

Cut  thin  slices  of  bread,  and  from  them  make  oblongs  an 
inch  wide  by  four  inches  long.  Toast  carefully  so  that  they 
will  not  breaks  and  pile  on  a  small  bread-plate  with  doily  if 
they  are  to  be  served  dry. 

TOAST  STICKS 

Take  a  slice  of  fresh  home-made  bread  (made  without  short^ 
ening)^  or  French  bread^  cut  five-eighths  of  an  inch  thick^  re' 
move  crust  and  cut  in  narrow  strips.  Place  on  rack  in  pan 
and  dry  and  brown  in  a  slow  oven. 

CROUTONS 

See  chapter  "  Soup  Accompaniments "  for  recipe.  Pagt 
230. 

GLTTTEN  CRISP   (FOR  THE  DIABETIC) 

Cut  Gum  Gluten  Bread  into  thin  slices,  and  dry  in  slow 
oven  until  the  moistening  is  thoroughly  evaporated,  or  the 
bread  may  be  cut  in  cubes  and  slightly  browned.  Serve  in 
soups  or  in  milk. 

Note. —  Gluten  Biscuit  Crisps,  page  261. 

WATER  TOAST 

Toast  the  bread.  Dip  quickly  in  boiling  salted  water  (al- 
lowing one-half  teaspoon  salt  to  one  cup  water).  Spread 
with  butter.    Serve  on  hot  plate. 

TOASTED  CRACKERS 

1  Saltine=15  Calories. 
Toast  oblong  crackers  daintily,  and  butter.    Serve  on  plate 
with  doily,  piled  log-cabin  fashion. 


TOAST 


357 


MILK  TOAST,  388  CALORIES 

Put  a  cup  of  rich  milk  in  a  saucepan  and  place  it  on  the 
stove.  While  it  is  heating,  toast  three  slices  of  bread  to  a 
delicate  brown.  Put  them  into  a  covered  dish,  and  when  the 
milk  is  scalding  hot,  season  it  with  a  saltspoon  of  salt,  and 
pour  it  over  the  toast. 

jN'ote. —  A  little  butter  may  be  spread  on  each  slice  before 
the  milk  is  added,  but  it  is  a  more  delicate  dish  without  it. 

CREAM  TOAST  NO.  I,  261  CALORIES 

(Individual  Rule.) 
%  tablespoon  butter.  %  cup  milk. 

%  tablespoon  flour.  1%  slices  bread. 

y2  saltspoon  salt. 

Scald  the  milk.  Melt  butter,  add  flour,  remove  from  fire 
and  add  the  milk  gradually.  Stir  over  heat  constantly  until 
smooth,  cooking  five  minutes  after  blending,  or  until  the 
starch  is  thoroughly  cooked. 

Toast:  Eemove  crust  if  desired,  cut  in  oblong  pieces  and 
toast.  Serve  on  small  platter  with  cream  sauce  poured  over 
it,  and  garnish  with  toast  points. 

Note. —  If  you  wish  the  toast  very  soft,  it  may  be  dipped 
very  quickly  in  boiling  salted  water  before  adding  the  cream 
sauce. 

CREAM  TOAST  NO.  II,  261  CALORIES 

l^  tablespoon  butter.  1  tablespoon  cold  water. 

14  tablespoon  flour.  %  cup  milk. 

1/2  saltspoon  salt.  1^2  slices  toast. 

Scald  milk.  Mix  fiour  and  salt  and  add  the  cold  water 
gradually,  making  a  smooth,  thin  paste.  Add  to  scalded 
milk;  cook  in  double  boiler  twenty  minutes,  stirring  con- 
stantly until  it  thickens.  Add  butter.  Pour  over  toast,  and 
serve  hot,  oxi  hot  platter. 

CELERY  TOAST 

4  ounces  celery  =^12  Calories. 
Clean  celery  and  cut  into  one-inch  pieces;  cover  with  boil- 
ing water  and  cook  until  tender ;  drain  off  water. 


258  VEGETABLE  OR  PLANT  FOODS 


Prepare  Cream  Sauce  in  Cream  Toast  No.  I;  add  cooked 
celery  and  pour  on  small  slices  of  buttered  toast.  Garnish 
with  toast  points. 

FRENCH  TOAST  (FOR  THE  DIABETIC),  144  CALORIES  i 

l^  cup  milk.  Salt. 

1  egg.  Gluten  bread. 

Beat  the  egg,  add  milk  and  salt;  dip  into  this  mixture 
slices  of  Gum  Gluten  bread.  Saute  and  brown  in  a  little 
butter. 

CLAM  BROTH  AND  TOAST 

Follow  directions  as  for  Milk  or  Cream  Toast^  adding  suffi- 
cient Clam  Broth  (to  taste)  to  the  Sauce^  and  pour  over  toast. 
Serve  hot. 

SANDWICHES 

TO  PREPARE  SANDWICHES 

Use  white^  entire  wheats  graham^  gluten  or  Boston  brown 
bread.  Bread  may  be  buttered  before  cutting  from  loaf, 
spread  with  soft^  plain  butter  cut  into  very  thin  slices,  cover 
with  another  slice,  press  together,  cut  in  fancy  shapes,  or 
roll.  Wrap  in  waxed  paper  or  cover  with  a  dry  napkin, 
over  which  place  a  slightly  moistened  one,  until  ready  to 
serve. 

Bread  may  be  baked  purposely  for  sandwiches  by  filling 
one-half  pound  baking  powder  boxes  half  full  of  dough,  let 
rise  and  bake.  Serve  sandwiches  on  a  dainty  doily  on  a 
small  plate. 

ENERGY  VALUE  OF  BREAD 


1  slice  (1  oz. )  white  bread  =73  Calories. 

1  slice  (1  oz. )  entire  wheat  bread  =70  Calories. 

1  slice  (1  oz.)  gluten  bread  =71  Calories. 

1  small  slice  (1  oz.)  Boston  Brown  Bread..  =64  Calories. 

1  teaspoon  butter  =36  Calories. 

See  Table,  page  64,  for  energy  value  of  other  ingredients. 


^  Calculated  without  bread. 


SANDWICHES 


259 


BREAD  AND  BUTTER  SANDWICHES 

Butter  bread  slightly^  cut  very  thin  and  put  slices  to- 
gether.   Cut  in  fancy  shapes. 

BOSTON  BROWN  BREAD  SANDWICHES 

Steam  Boston  brown  bread  in  one-half  pound  baking  pow- 
der cans.  Butter  and  cut  in  thin  slices  and  add  a  thin  round 
of  white  bread.  The  combination  of  the  two  makes  a  pleas- 
ing variety. 

CHEESE  SANDWICHES 

Chop  stuffed  olives  fine  and  add  equal  quantity  of  cream 
cheese  and  spread  on  bread  and  butter  sandwiches.  A  lettuce 
leaf  may  be  added  if  desired. 

CHICKEN  SANDWICHES 

Chop  cold  boiled  chicken,  add  mayonnaise  dressing  and 
spread  on  bread  and  butter  sandwiches. 

Or,  instead  of  mayonnaise,  moisten  with  strong  chicken 
broth  and  season  with  salt  and  pepper.  Minced  celery  may 
be  added. 

EGG  SANDWICHES 

See  chapter  "  Eggs    for  recipe.    Page  183. 

FRUIT  SANDWICHES 

Spread  bread  and  butter  sandwiches  with  stewed  dates, 
figs  or  prunes,  seasoned  with  a  little  lemon  juice  or  chop 
dates,  raisins  and  nuts  very  fine  and  moisten  with  "  Cream 
Dressing.^^    See  page  274. 

LETTUCE  SANDWICHES 

Spread  bread  and  butter  sandwiches  with  a  little  mayon- 
naise dressing,  lay  in  fresh,  crisp  lettuce  leaves  washed  and 
dried  thoroughly,  and  cut  even. 

NUT  SANDWICHES 

Prepare  same  as  lettuce  sandwiches,  adding  chopped  nuts 
to  the  mayonnaise. 


360  VEGETABLE  OR  PLANT  FOODS 


PEPTONOIDS  SANDWICHES 

Cut  slices  of  bread  in  fancy  shapes,  butter  and  spread  with 
layer  of  Dry  Peptonoids  Soluble,  adding  salt,  pepper,  paprika 
or  celery  salt,  if  desired. 

Note. —  Dry  Peptonoids  Soluble  may  be  blended  with 
mayonnaise  dressing,  cream,  chopped  nuts  or  eggs,  for  filling. 

RAW  BEEF  SANDWICHES 

See  chapter  "Beef  Preparations''  for  recipe.    Page  317. 
SARDINE  SANDWICHES 

Bemove  oil  and  bones  from  canned  sardines.  Mix  with 
Boiled  Dressing  (page  373)  to  form  a  paste  and  spread. 
Chopped  olives  or  gherkins  may  be  added. 

CRACKERS  —  WAFERS 

BRAN  CRACKERS,  1513  CALORIES  i 

ll^  cups  wheat  bran.  l^  teaspoon  salt. 

ll^  cups  sifted  flour.  4  tablespoons  butter. 

1  teaspoon  cream  of  tartar.  Milk. 
%  teaspoon  soda. 

Blend  all  ingredients,  using  enough  cold  milk  to  make  a 
stiff  dough.  Eoll  to  one-eighth  inch  thickness  and  cut  with 
a  small  biscuit  cutter.  Great  care  is  needed  in  baking  that 
they  do  not  burn  and  at  the  same  time  that  they  are  thor- 
oughly cooked. 

They  keep  well  a  long  time  if  put  in  a  tin  box. 

They  should  be  eaten  at  each  meal  if  needed  as  purgative 
medicine. 

GLUTEN  CRACKERS  (FOR  THE  DIABETIC),  2555  CALORIES 

1  pound  Gum  Gluten  Flour.  Sweetina. 
l^  pound  butter.  Cold  water. 

,Salt. 

^Without  milk. 


CRACKERS— WAFERS 


361 


Mix  thoroughly  the  Gum  Gluten  Flour  with  the  butter, 
add  salt  and  Sweetina  to  taste.  Add  cold  water  to  make  a 
soft  dough.  Toss  on  floured  board,  roll  thin,  cut  into  shape, 
bake. 

GLUTEN  WAFERS  (FOR  THE  DIABETIC) 

l^  cup  thick  cream  =  432  Cal-       Gum  Gluten  Flour  (1  cup  =  513 

ories.  Calories ) . 

1  saltspoon  salt. 

Add  -salt  to  the  cream  and  add  the  Gluten  gradually  to 
make  a  stiff  dough.  Toss  on  a  floured  board  and  roll  as 
thinly  as  possible  and  cut  in  strips  with  sharp  knife  or  shape 
with  a  cutter.  Bake  in  a  buttered  sheet  in  a  slow  oven  until 
delicately  browned. 

GLUTEN  BISCUIT  CRISPS  (FOR  THE  DIABETIC) 

1  biscuit  crisp  =  25  Calories. 
Gum  Gluten  Biscuit  Crisps  may  be  served  plain,  or  but- 
tered and  heated  slightly  in  oven. 

GLUTEN  CHEESE  WAFERS  (FOR  THE  DIABETIC),  882  CALORIES 

1  cup  Gum  Gluten  Flour.  Yolks  2  eggs. 

3  tablespoons  cream.  1  saltspoon  salt. 

3  tablespoons  grated  cheese.  ^Tutmeg. 

Mix  in  order  given,  roll  thin  and  bake.  ^ 

VEGETABLES  — VEGETABLE  SAUCES 

LEGUMES  —  ROOTS  AND  TUBERS  — GREEN  VEGETABLES 

Vegetables  include  nearly  all  kinds  of  plant  food  except 
fruits,  grains  and  nuts. 

Classification.    Vegetables  are  classified  as  — 
Legumes  —  as  peas,  beans  and  lentils. 
Koots  and  Tubers  —  as  potatoes,  beets,  turnips,  etc. 
Green  Vegetables  —  as  lettuce,  spinach,  celery,  etc. 
Composition.    All  vegetables  have  a  high  percentage  of 
water,  and  with  the  exception  of  legumes,  a  relatively  small 
proportion  of  protein.    The  chief  nutrients  are  starch  and 


262  VEGETABLE  OR  PLANT  FOODS 


sugar.  The  fats  are  usually  small  in  amount  and  chiefly  in 
the  form  of  oils.  A  variety  of  mineral  salts  are  present^ 
chiefly  salts  of  potash  and  soda  united  with  organic  acids. 
Vegetables  give  bulk  to  food  and  possess  antiscorbutic  prop- 
erties. 

Digestibility,  As  the  gastric  ferments  play  no  part  in 
carbohydrate  digestion^  vegetables  are  digested  mainly  in  the 
intestines.  The  presence  of  cellulose  prevents  the  ready  di- 
gestion of  the  nutrients,  hence  it  may  be  stated  as  a  general 
rule  that  vegetable  food  is*  less  completely  digested  and  ab- 
sorbed than  animal  food.  It  would  seem  desirable  to  restrict 
this  type  of  food  for  persons  of  very  weak  digestive  powers. 

General  Rules  for  Cooking  Vegetables.  Wash  thoroughly ; 
pare,  peel,  or  scrape,  according  to  the  kind.  Let  them  stand 
in  cold  water  until  ready  to  cook,  to  keep  them  crisp,  to 
freshen  them  when  wilted,  or  to  prevent  them  from  turning 
dark. 

Cook  in  enough  freshly  boiling  salted  water  to  cover,  and 
keep  the  water  boiling  (not  rapid  boiling,  as  tender  vegetables 
are  easily  broken).  Allow  one  teaspoon  of  salt  to  one  quart 
of  water.  Salt  may  be  added  when  vegetables  are  put  in, 
except  in  the  case  of  delicate  green  vegetables,  as  peas, 
spinach,  etc.,  when  it  should  not  be  added  until  nearly  done. 
To  preserve  the  color,  cook  green  vegetables  uncovered. 

Vegetables  should  be  cooked  only  until  tender,  drained  im- 
mediately, and  served  promptly.  Overcooking  injures  their 
flavor  and  makes  them  tough.  Time  for  cooking  vegetables 
varies  with  the  size,  age  and  freshness. 

Legumes.  Of  this  class  of  food-stuffs,  peas  and  beans  are 
the  most  important.  Lentils  and  peanuts  are  also  valuable, 
but  less  widely  used. 

Composition,  Fresh  legumes,  such  as  peas  and  beans,  con- 
tain from  2  per  cent,  to  9  per  cent,  of  protein,  a  trace  of  fat 
and  from  7  per  cent,  to  30  per  cent,  of  carbohydrate. 

Dried  legumes,  such  as  dried  peas  and  beans,  on  account 
of  the  lessened  amount  of  water,  contain  from  18  per  cent,  to 
35  per  cent,  of  protein,  over  1  per  cent,  fat,  and  as  high  as 


VEGETABLES 


263 


65  per  cent,  carbohj^drate.  They  form  one  of  the  chief  sources 
of  protein  in  a  strictly  vegetarian  diet. 

Digestibility.  Digestibility  depends  largely  upon  the 
method  of  cooking  and  the  amount  eaten.  The  more  the 
cellulose  is  softened  or  removed,  the  more  completely  they 
are  utilized.  Legumes  are  apt  to  produce  fermentation, 
which  causes  flatulence  and  gastro-intestinal  disturbance. 
They  are  more  suitable  for  those  leading  an  active  outdoor 
life  than  for  invalids,  convalescents,  or  those  of  sedentary 
habits. 

Principles  of  Cooking,  The  attractiveness  and  digestibility 
of  dried  legumes  depends  very  greatly  on  proper  cooking. 
Hard  water  must  not  be  used,  as  it  makes  them  hard  and 
unpalatable,  and  causes  a  considerable  loss  of  protein. 
Water  softened  by  boiling  is  more  desirable  than  that  soft- 
ened by  baking  soda.  When  cooked  in  the  former,  the  dried 
legumes,  especially  beans,  keep  their  shape  better,  are  only 
very  slightly  colored  yellow,  and  are  more  mealy,  conse- 
quently more  digestible,  as  the  digestive  juices  can  more 
easily  mingle  with  the  particles  of  the  food. 

Roots  and  Tubers.  Eoots  and  tubers  contain  the  reserve 
material  stored  up  by  the  plant,  and  some  of  them  are  among 
the  important  food-stufls.  Their  nutritive  value  is  largely 
due  to  starch  and  sugar.  On  account  of  the  small  proportion 
of  protein  and  fat,  and  the  large  proportion  of  water,  they 
are  inferior  in  nutritive  value  to  both  legumes  and  cereals. 
The  mineral  matter  is  an  important  constituent  of  these,  as 
of  other  vegetable  foods.  Sodium,  potassium  and  iron  salts, 
and  sulphur  a-nd  phosphorus  compounds,  are  the  common  ash 
constituents.  In  combination  with  organic  acids,  etc.,  they 
contribute  much  to  the  flavor  of  these  foods. 

As  a  class  they  may  be  divided  into  the  following  groups : 

1.  Starch-yielding  vegetables,  as  potatoes  and  sweet  pota- 
toes. 

2.  Succulent  roots,  as  beets,  carrots,  parsnips  and  onions. 

3.  Condimental  or  flavoring  roots,  as  horse-radish  and  gin- 
ger. 


264  VEGETABLE  OR  PLANT  FOODS 


The  potato  is  the  most  important  of  the  starch-yielding 
class  of  vegetables.  It  is  a  tuber  or  thickened  underground 
stem. 

The  composition  of  the  potato  (Letheby)  is  as  follows : 


When  pared  before  cooking^  there  may  be  a  considerable 
loss  of  nutritive  material^  especially  of  mineral  matter.  By 
cooking  in  the  skin^  this  loss  is  largely  prevented.  To  be 
easily  digestible^  a  potato  must  be  mealy^  so  as  to  be  readily 
acted  on  by  digestive  juices.  This  is  best  accomplished  by 
baking  in  an  oven  at  380  to  400°  F.  When  a  patient  begins 
to  take  solids^  the  vegetable  usually  first  prescribed  is  a  baked 
potato. 

Beets,  carrots,  parsnips,  salsify,  turnips  and  onions  are 
the  most  common  of  the  class  of  succulent  roots.  They  con- 
tain, as  a  rule,  more  water  than  the  starch-yielding  class  of 
vegetables,  and  their  carbohydrates  are  frequently  in  the  form 
of  sugars,  pectins,  and  other  polysaccharide  carbohydrates 
than  true  starch,  some  of  which  have  no  nutritive  value.  The 
percentage  of  crude  fiber  is  greater  than  in  the  starch-yield- 
ing class. 

The  characteristic  flavors  and  odors  are  in  many  cases  due 
to  the  presence  of  volatile  organic  compounds  of  sulphur. 
These  are  often  advantageous  in  making  the  vegetables  pal- 
atable, and  adding  variety  to  the  diet. 

The  beet  contains  a  large  percentage  of  starch  and  sugar. 

Carrots  and  parsnips  also  contain  much  sugar,  and  when 
young  and  tender  form  a  very  nutritious  food. 

Onions  contain  considerable  nutriment,  but  are  most  val- 
uable for  their  pungent  oil,  which  is  rich  in  sulphur.  They 
have  diuretic  properties,  and  are  useful  in  constipation. 

Eadishes  contain  a  large  amount  of  cellulose  and  should 
not  be  eaten  by  invalids.    They  are  chiefly  used  as  a  relish. 


Sugar 
Fat  .. 


Water 
Starch 


Nitrogenous  matter 


75.00  per  cent. 

18.80  per  cent. 

2.00  per  cent. 

3.00  per  cent. 

.20  per  cent. 


VEGETABLES 


265 


Green  Vegetables.  These  vegetables  have  a  fuel  value  of 
less  than  200  calories  per  pound;  they  are  useful  chiefly  for 
their  mineral  salts^  and  for  the  bulk^  variety  and  relish  they 
give  to  the  diet. 

Asparagus  is  easily  digested^  even  by  invalids.  It  has  a 
diuretic  action,  and  imparts  a  characteristic  odor  to  the  urine 
for  some  hours. 

Cabbage  contains  considerable  sulphur  and  therefore  fre- 
quently causes  flatulence. 

Cauliflower  belongs  to  the  cabbage  family,  but  is  easily 
digested. 

Celery  is  more  digestible  cooked  than  raw. 

Spinach  is  especially  valuable  for  its  large  amount  of  iron. 

ENERGY  VALTJE  OF  THE  POTATO 

1  medium  potato  (3%  ozs.)  =83  Calories. 
See  Table,  page  64,  for  energy  value  of  other  ingredients. 

BOILED  POTATOES 

Select  potatoes  of  uniform  size.  Wash,  pare  and  put  into 
cold  water  to  keep  from  discoloring.  Put  them  into  sauce- 
pan, cover  with  boiling  water,  boil  and  when  partly  cooked, 
add  one  tablespoon  salt  to  every  six  potatoes.  Cook  until 
soft,  about  twenty-flve  to  thirty  minutes,  drain  very  dry,  and 
shake  the  pan,  without  a  cover,  gently  over  the  stove  till 
the  potatoes  are  mealy.    Do  not  serve  in  covered  dish. 

RICED  POTATOES 

Add  salt  and  pepper  to  boiled  potatoes,  and  rub  them 
through  a  heated  potato-ricer  or  squash-strainer  into  the  (hot) 
dish  they  are  to  be  served  in.  Serve  immediately,  or  pour 
a  little  milk  over  the  top  and  brown  in  the  oven. 

MASHED  POTATOES,  305  CALORIES 

For  mashed  potatoes  the  uneven  sizes  may  be  used;  the 
larger  ones  should  be  cut,  so  all  will  be  of  uniform  size. 
Prepare  as  for  boiled  potatoes.  When  cooked  and  dried,  add 
salt,  butter,  pepper  and  cream  in  following  proportion : 


266 


VEGETABLE  OB  PLANT  FOODS 


1  pint  potatoes. 
14  teaspoon  salt. 
1  tablespoon  butter. 


%  saltspoon  white  pepper. 

2  teaspoons  hot  cream  or  milk. 


To  the  potatoes  add  the  salt^  pepper  and  butter^  and  mash, 
leaving  them  in  saucepan  cooked  in,  and  on  stove  so  as  to 
keep  them  hot.  Use  open-wire  masher  or  fork  and  beat 
quickly,  so  they  may  be  light  and  dry,  not  gummy.^'  Lastly 
put  in  the  cream,  beat  for  a  moment  and  serve  immediately. 

POTATO  CAKES 

From  cold  mashed  potatoes  make  slightly  flattened  balls. 
Put  them  in  a  floured  tin,  brush  each  over  with  milk  and 
bake  in  a  hot  oven  five  minutes,  or  till  a  delicate  brown. 

Note. —  These  cakes  may  be  sauteed  in  a  little  beef  fat  or 
butter  if  desired. 

SURPRISE  BALXS 

EoU  the  potatoes  into  balls  as  above,  and  with  a  teaspoon 
press  a  hollow  in  the  top.  Chop  fine  some  cold,  lean  meat, 
season  it  with  salt,  pepper  and  gravy  and  put  one  teaspoon 
of  the  meat  into  the  hollow  of  the  potato  ball.  Put  a  little 
milk  or  melted  butter  on  top  and  brown  in  oven  or  saute. 

BAKED  POTATOES 

Select  potatoes  of  uniform  size,  not  very  large,  w^ash  and 
scrub  thoroughly,  cut  oft'  a  small  piece  at  each  end  in  order 
that  the  steam  may  escape.  Bake  in  hot  oven  from  forty-five 
to  fifty  minutes.  When  baked  break  open  slightly,  that  steam 
may  escape,  and  serve  on  folded  napkin. 

POTATOES  BAKED  IN  THE  HALF  SHELL 

Cut  off  top  of  baked  potato  and  scoop  out  inside.  Mash 
and  season  well  as  for  mashed  potatoes  and  add  the  well- 
beaten  white  of  egg.  Pill  the  skins  with  the  mixture,  heap- 
ing it  lightly  on  top,  brush  over  with  milk  or  slightly  beaten 
white  of  egg  and  brown  slightly.  Potatoes  may  be  sprinkled 
with  grated  cheese  before  putting  into  oven. 


VEGETABLES 


267 


POTATOES  AU  GRATIN 

Cut  cold  boiled  potatoes  into  cubes  and  put  into  a  buttered 
baking  dish.  Cover  with  white  saucC;,  put  buttered  cracker 
or  bread  crumbs  on  top  and  bake  until  golden  brown. 

Note. —  A  little  grated  cheese  added  to  the  White  Sauce 
just  before  pouring  over  the  potatoes  adds  a  pleasant  flavor. 

CREAMED  POTATOES,  180  CALORIES 

1  cup  cold  sliced  or  cubed  po-  14  teaspoon  salt. 

tatoes.  l^  teaspoon  finely  chopped  pars- 

V4:  cup  milk.  ley. 
1/2  tablespoon  butter.  Speck  white  pepper. 

Heat  the  milk,  add  the  potatoes,  and  cook  until  they  have 
nearly  absorbed  the  milk.  Add  butter  and  seasoning,  cook 
five  minutes  longer,  add  parsley  and  serve  hot. 

POTATO  BALLS 

From  large  potatoes  cut  balls  with  a  French  potato  cutter 
and  throw  them  into  cold  water.  Cook  for  twelve  minutes 
or  more  in  enough  boiling  water  to  cover.  Salt  at  end  of 
six  minutes.  Drain  and  let  them  stand  a  few  minutes  to 
dry.  Serve  as  a  vegetable,  with  cream  sauce,  or  with  parsley 
hutter,  or  use  as  a  garnish  for  broiled  fish.  Test  potatoes 
with  a  needle  to  see  when  tender. 

Note. —  Make  mashed  potatoes  from  frames  left  after  cut- 
ting out  the  balls. 

PARSLEY  BUTTER,  358  CALORIES 
1  tablespoon  butter.  Juice  l^  lemon. 

1  teaspoon  chopped  parsley.  1  pint  potato  balls. 

Cream  the  butter,  add  lemon  juice  and  chopped  parsley. 
Add  to  the  hot  potato  balls,  heat  five  minutes  and  serve. 
Omit  lemon  juice  if  desired. 

ASPARAGUS 

^4  bunch  asparagus  =60  Calories. 

1  slice  toast  (1  oz.)  =73  Calories. 

Boiled  Asparagus.  Prepare  asparagus  by  cutting  off  lower 
part  of  stalk  at  the  point  at  which  they  will  snap.  Wash, 


268  VEGETABLE  OR  PLANT  FOODS 


remove  scales  and  tie  together  or  cut  into  one  inch  pieces 
Cook  in  boiling  salted  water  until  soft,  twenty  to  thirty-five 
minutes.  As  the  tips  are  more  tender  keep  them  out  of  water 
the  first  ten  minutes  of  the  cooking.  Drain,  place  in  hot 
serving  dish,  spread  with  one-half  teaspoon  butter  and  sprin- 
kle with  salt. 

Asparagus  on  Toast.  Serve  boiled  asparagus  on  buttered 
toast,  moistened  with  a  little  of  the  liquid  the  asparagus  is 
cooked  in. 

Cream  Asparagus,  Plain  Or  on  Toast,  Pour  Cream  Sauce 
No.  I  over  boiled  asparagus  and  serve  hot,  or  serve  boiled 
asparagus  on  toast  and  pour  Cream  Sauce  N^o.  I  over  same. 

CARROTS 
1  small  carrot  (2  ozs.)  =20  Calories. 
Boiled  Carrots.  Wash,  scrub  and  scrape  off  the  very  thin 
skin.  Cut  each  carrot  into  slices  from  one-fourth  to  one- 
fifth  inch  thick,  cut  into  cubes  and  cook  in  boiling  salted 
water  until  soft,  forty-five  to  sixty  minutes.  They  may  be 
served  plain  with  a  little  melted  butter,  salt  and  pepper,  or 
they  may  be  mashed  and  seasoned  as  above. 

Creamed  Carrots.  Pour  Creamed  Sauce  No.  I  over  boiled 
cubed  carrot,  reheat  and  serve. 

CAULIFLOWER 
1  serving  ( 4  ozs. )  =  35  Calories. 
Boiled  Cauliflower.    Cut  off  stalk  and  remove  leaves  of 
cauliflower.    Soak  thirty  minutes  in  cold  water  to  cover,  head 
down.    Cook,  head  up,  twenty  to  thirty  minutes,  or  until  soft, 
in  boiling  salted  water.    Drain  and  separate  flowerets. 

Creamed  Cauliflower.  Pour  Cream  Sauce  No.  I  over  boiled 
cauliflower,  reheat  and  serve. 

CELERY 
1  serving  ( 2  ozs. )  =  6  Calories. 
Scrape  celery.    Cut  stalks  in  one-half  inch  pieces  and 
cook  uncovered  in  boiling  salted  water  twenty  to  thirty  min- 
utes.   Serve  with  Cream.  Sauce  No.  I  poured  over  it.  Sauce 


VEGETABLES 


269 


can  be  made  using  part  milk  and  part  water  in  which  celery- 
was  cooked. 

SPINACH  —  DANDELIONS  —  BEET  GREENS 

1  serving  (4  ozs.)  =27  Calories. 
Eemove  roots^  pick  over  carefully  (discarding  wilted  leaves) 
and  wash  thoroughly  in  many  waters  until  free  from  sand; 
€Ook  in  boiling  salted  water^  allowing  one-fourth  as  much 
water  as  greens.  Cook  twenty-five  to  thirty  minutes.  Drain 
and  chop  if  desired^  reheat^  season  with  butter  and  salt;  gar- 
nish with  slices  of  hard-cooked  egg.    Serve  with  vinegar. 

ONIONS 

1  serving  (4  ozs.)  =56  Calories. 

Boiled  Onions.  Put  onions  into  pan  of  cold  water  and  peel 
under  water.  Put  them  into  boiling  water  with  one  teaspoon 
salt  and  one-fourth  teaspoon  soda  to  one  quart  water.  After 
■cooking  five  minutes  pour  off  the  water  and  add  fresh  boiling 
salted  water;,  and  after  ten  minutes  change  the  water  again. 
Boil  until  tender  —  forty-five  to  sixty  minutes.  Drain  off 
the  water  and  add  a  little  milk^  cook  a  few  moments  and  add 
butter^  salt  and  pepper. 

Creamed  Onions,  Pour  Cream  Sauce  KTo.  I  over  boiled 
onions,  reheat  and  serve. 

Scalloped  Onions,  Place  onions  in  a  baking  dish  and  add 
Cream  Sauce  N'o.  I.  Cover  top  with  buttered  cracker  or 
hread  crumbs  and  bake  until  crumbs  are  a  golden  brown. 

PEAS  (GREEN  OR  CANNED) 

1  serving  (4  ozs.)  =114  Calories. 
Green  Peas.  Eemove  peas  from  pods,  cover  with  cold 
water  and  let  stand  one-half  hour.  Skim  off  small  peas  that 
€ome  to  the  top  and  drain  remaining  peas.  Cook  until  soft, 
thirty  to  forty-five  minutes,  in  a  small  quantity  of  water. 
There  should  be  little  or  no  water  to  drain  from  peas  when 
they  are  cooked.  A  small  quantity  of  sugar  may  be  added 
if  the  natural  sweetness  of  the  peas  has  been  lost.  Season 
with  butter  and  salt. 


270  VEGETABLE  OR  PLANT  FOODS 


Canned  Peas  should  be  drained  and  thoroughly  rinsed, 
cover  with  boiling  water,  boil  two  minutes  and  again  drain, 
then  add  a  small  quantity  of  boiling  water  and  cook  from 
five  to  ten  minutes.    Season  with  butter,  salt  and  pepper. 

Creamed  Peas  No.  L  To  one-third  cup  of  cooked  peas 
add  one  teaspoon  of  flour  mixed  with  one-eighth  teaspoon  of 
sugar.  Cook  slightly  and  add  one  tablespoon  of  cream,  and 
salt  and  pepper  to  taste.  =  75  calories. 

Creamed  Peas  No,  II,  Pour  Cream  Sauce  N"Oo  I  over 
drained  cooked  peas,  reheat  and  serve. 

STRING  BEANS 

1  serving  (4  ozs.)  =:44  Calories. 

Eemove  strings  from  beans  and  cut  or  snap  into  one  inch 
pieces.  Wash  and  cook  in  boiling  water  until  tender  (one 
to  three  hours).  Drain  and  season  with  butter  and  salt. 
Cook  beans  in  as  little  water  as  possible.  Select  fresh  beans 
that  will  snap  easily. 

STEWED  TOMATOES 

1  medium  tomato   16  Calories. 

1  cup  canned  tomato  =51  Calories. 

Canned  or  fresh  tomatoes  may  be  used.  To  prepare  fresh 
tomatoes  wash,  pour  boiling  water  over  them  and  then  peel 
and  cut  into  pieces,  put  in  saucepan  and  cook  slowly  twenty 
minutes,  stirring  occasionally.  Add  a  few  bread  or  cracker 
crumbs  and  season  with  butter,  salt  and  pepper.  Bread  and 
cracker  crumbs  may  be  omitted.  A  little  sugar  may  be  added 
if  tomatoes  are  very  acid. 

BAKED  TOMATOES 

1  medium  tomato  =  16  Calories. 
Wash,  dry  and  remove  a  thin  slice  from  stem  end  of  to- 
mato. Eemove  seeds  and  pulp,  and  drain  off  most  of  the 
liquid;  to  the  pulp  add  an  equal  quantity  of  cracker  crumbs, 
season  with  salt  and  pepper  and  a  little  chopped  onion,  or  a 
few  drops  of  onion  juice.    Eefill  tomatoes  with  mixture  and 


VEGETABLE  SAUCES 


271 


place  in  a  buttered  tin;  sprinkle  with  buttered  cracker 
crumbs^,  bake  twenty  to  thirty  minutes  in  a  hot  oven. 

SCALLOPED  TOMATOES  (FOR  THE  DIABETIC),  165  CALORIES 

(Individual  Rule.) 


Into  a  well-buttered  individual  baking  dish  place  one 
crushed  Biscuit  Crisp;  and  place  on  top  of  this  one-half 
the  tomato,  from  which  the  skin  has  been  removed  and  then 
cut  in  small  pieces;  season  well  with  salt,  pepper  and  bits  of 
butter.  Add  another  layer  of  crumbs  (one  crushed  Biscuit 
Crisp),  then  the  remaining  tomato  and  seasoning,  lastly 
crumbs.  Place  bits  of  butter  on  top,  put  in  slow  oven  and 
bake  twenty  to  thirty  minutes. 

VEGETABLE  SAUCES 

CREAM  OR  WHITE  SAUCE  NO.  I,  152  CALORIES  i 

Use  to  pour  over  any  vegetable. 
(Individual  Rule.) 
1/2  cup  milk  or  thin  cream.  i/4  saltspoon  salt. 

1/^  tablespoon  butter.  Speck  white  pepper. 

y2  tablespoon  flour. 

Scald  the  milk.  Melt  the  butter  in  a  saucepan^  remove 
from  stove,  add  the  flour,  then  the  scalding  milk  gradually, 
put  over  heat  and  cook,  stirring  constantly,  until  smooth 
and  there  is  no  raw  taste  of  starch. 

This  sauce  may  be  used  in  many  ways  —  with  creamed  oys- 
ters, sweetbreads,  any  cream  dish  or  any  scalloped  dish.  If 
a  thick  sauce  is  desired,  use  one  tablespoon  of  flour  in  place 
of  one-half. 


I  large  ripe  tomato. 
Salt,  pepper. 


3  Gum  Gluten  Biscuit  Crisps. 
2  teaspoons  butter. 


CREAM  SAUCE  NO.  II,  134  CALORIES 

(Individual  Rule.) 


cup  milk  or  thin  cream.  1  teaspoon  butter. 

%  tablespoon  flour.  %  teaspoon  salt. 


^  Calculated  with  milk. 


272  VEGETABLE  OB  PLANT  FOODS 


Scald  the  cream.  Wet  the  flour  with  a  little  cold  milk  to 
make  a  smooth  mixture,  and  add  to  the  hot  cream.  Cook 
well.  Just  before  serving  add  the  butter  and  salt,  and  pep- 
per if  desired. 

Sauce  blended  in  this  way  is  especially  easy  of  digestion. 
If  a  thick  sauce  is  desired,  use  one  tablespoon  of  flour  in  place 
of  one-half. 

SALADS  AND  SALAD  DRESSINGS 

The  salad  plants,  such  as  lettuce,  celery,  water  cress,  en- 
dives, etc.,  contain  little  nutriment,  but  are  especially  rich 
in  mineral  matter,  and  served  uncooked  in  the  form  of  salad, 
all  this  mineral  matter  iz  preserved.  They  are  very  valuable, 
•  as  these  mineral  substances  are  necessary  for  the  healthy 
condition  of  the  blood  and  should  form  a  large  part  of  the 
daily  diet. 

Salads  should  not  be  eaten  by  dyspeptics  or  those  having 
delicate  bowels. 

Salads  should  be  prepared  daintily,  arranged  attractively 
and  always  be  served  cold.  Lettuce  and  other  salad  plants 
should  be  fresh,  crisp,  and  dry.  Wash  thoroughly,  on  account 
of  danger  of  germs  from  dust,  soil,  etc.,  chill  in  very  cold 
water  until  crisp  and  dry  by  placing  on  a  clean  towel  so  that 
the  water  will  drain  from  the  leaves ;  or  fold  lightly  in  a 
towel  and  place  on  ice  until  serving  time.  Parsley  is  re- 
vived quickly  by  sprinkling  with  cold  water  and  putting  it 
into  an  air-tight  fruit  jar  and  keeping  it  in  a  cold  place. 
Treated  in  this  way  it  will  keep  fresh  a  long  time. 

Dressing  should  not  be  added  to  green  vegetables  until 
just  before  serving^  as  it  tends  to  wilt  them. 

Meat  to  be  used  in  salads  should  be  free  from  skin  and 
gristle,  and  should  be  cut  into  small  cubes,  mixed  with  French 
dressing  and  allowed  to  stand  some  time  before  combining 
with  the  vegetables. 

A  dainty  salad  served  with  a  crisp  cracker  or  cheese  wafer 


SALAD  DRESSING 


273 


forms  an  acceptable  luncheon  for  the  convalescent.  It  may 
also  be  served  with  dinner. 

FEENCH  DRESSING,  270  CALORIES 

(Individual  Rule,  %  of  Recipe.) 

1  tablespoon  vinegar.  Vs  teaspoon  salt. 

2  tablespoons  Nicelle  olive  oil.      %  saltspoon  pepper. 

Mix  all  ingredients  thoroughly  and  pour  over  salad  just 
before  serving. 

BOILED  DRESSING,  483  CALORIES 

(Individual  Rule,  %  of  Recipe.) 

1  teaspoon  salt.  1  egg. 

%  teaspoon  mustard.  l^  cup  milk. 

Speck  cayenne.  2  tablespoons  butter. 

2  tablespoons  sugar.  l^  cup  vinegar. 

Mix  all  dry  ingredients.  Beat  egg  in  double  boiler,  add 
dry  ingredients,  butter  and  milk;  cook  over  hot  water,  stir- 
ring constantly  until  thick  like  custard;  add  vinegar;  cool 
and  serve. 

Note. —  If  it  curdles,  beat  over  cold  water  until  smooth. 

MAYONNAISE  DRESSING,  2570  CALORIES 

(Individual  Rule,  ^  of  Recipe.) 

1  teaspoon  mustard.  Yolks  2  eggs. 

2  teaspoons  powdered  sugar.         ll^  cups  Nicelle  olive  oil. 
1  teaspoon  salt.  2  tablespoons  vinegar. 
Speck  cayenne.  2  tablespoons  lemon  juice. 

Mix  dry  ingredients,  add  to  yolks  and  mix  thoroughly. 
Add  a  few  drops  of  oil  at  a  time  until  one-half  cup  is  used, 
beating  with  egg-beater  or  wooden  spoon.  Then  add  al- 
ternately a  few  drops  of  vinegar  and  lemon  juice  and  the 
remainder  of  the  oil,  using  care  not  to  lose  the  stiff  con- 
sistency. It  should  be  a  thick  dressing  and  not  added  to 
food  until  just  before  serving. 

Note. —  Have  all  ingredients  and  utensils  thoroughly 
chilled  and  place  mixing  bowl  in  a  pan  of  crushed  ice  while 
blending. 


374 


VEGETABLE  OR  PLANT  FOODS 


If  dressing  curdles^  take  another  egg  yolk  and  add  the 
curdled  mixture  to  it  slowly,  beating  constantly. 

Note. —  One-half  or  one-fourth  of  recipe  may  be  prepared. 
As  it  will  keep  well  it  is  best  to  prepare  in  larger  quantity, 
thus  saving  labor. 

CREAM  DRESSING,  1697  CALORIES 

(For  Fruit  Salads.) 

l^  cup  butter.  1  teaspoon  mustard. 

2  tablespoons  flour.  .          1  tablespoon  cider  vinegar.. 

1  cup  scalded  milk.  1  teaspoon  salt. 

3  yolks  of  eggs.  Yo  cup  vinegar. 
3  whites  of  eggs.  %  ^^^P  sugar. 

(a)  Melt  butter  in  a  saucepan^  add  flour  and  pour  on 
gradually  the  scalding  milk,  cook  thoroughly,  stirring  con- 
stantly, (h)  Beat  yolks  in  top  of  double  boiler,  add  the 
mustard  (dissolved  in  one  tablespoon  of  vinegar),  salt  and 
vinegar.  Pour  (a)  gradually  on  the  egg  mixture  and  cook 
over  hot  water  until  it  thickens  like  soft  custard,  remove  from 
fire,  add  the  sugar  and  fold  in  the  stiffly-beaten  white  of  eggs. 
Pour  into  glass  fruit  jar,  cool  and  cover  and  keep  on  ice. 
This  dressing  will  keep  a  long  time  and  is  especially  delicious 
to  serve  with  fruit  salads. 

CHICKEN  SALAD,  856  CALORIES 

(Six  Servings.) 

2  cups  cut  chicken.  1/2  saltspoon  pepper. 

1  cup  cut  celery.  1  tablespoon  vinegar. 

2  tablespoons  Nicelle  olive  oil.      2  tablespoons  mayonnaise. 
1  saltspoon  salt. 

Mayonnaise,  olives,  celery  leaves  or  white  lettuce  for  gar- 
nishing. 

Cut  the  cold  chicken  into  small  dice ;  cut  the  cleaned  celery 
into  small  uniform  pieces.  Mix  these  together  and  pour  over 
the  oil.  Mix  well,  then  sprinkle  with  salt  and  pepper  to 
taste;  add  the  vinegar,  blend  and  put  in  colander  to  drain; 
set  in  a  cold  place  for  two  or  three  hours.  Just  before  serv- 
ing add  the  mayonnaise,  put  on  a  bed  of  lettuce  and  garnish. 

Note. —  Do  not  mince  chicken. 


SALADS 


275 


FRUIT  SALADS 

Any  combination  of  fruit  desired  may  be  used  served  with 
Cream  Dressing/^  An  attractive  combination  is  a  banana 
peeled,  cut  in  half  crosswise.  Cut  one-half  lengthwise,  ar- 
range on  lettuce  leaf,  add  a  little  Cream  Dressing  and  gar- 
nish with  malaga  grapes  (cut  in  half  and  seeded)  and  small 
pieces  of  English  walnuts. 

MARGUERITE  SALAD 

One  hard-cooked  egg  cut  crosswise.  Eemove  yolk.  Cut 
white  in  slices,  petal  fashion,  arrange  on  lettuce  leaf  like  a 
marguerite  and  fill  the  center  with  the  yolk  put  through  the 
potato-ricer  or  strainer.  Garnish  with  parsley  and  serve 
with  French,  boiled  or  mayonnaise  dressing. 

MIXED  SALAD 

Equal  proportions  of  green  peas  (cooked  and  drained), 
celery  cut  in  thin  slices  and  English  walnuts  cut  into  small 
pieces.  Season  with  salt  and  pepper,  add  mayonnaise  and 
serve  on  lettuce  leaves.  Garnish  with  ripe  cherries  on  the 
stem  with  blanched  hazel  nuts  put  in  place  of  stones. 

SWEETBREAD  SALAD 

Mix  equal  parts  of  parboiled  sweetbreads  cut  into  one-half 
inch  cubes  and  celery  cut  into  thin  slices.  Season  with  salt 
and  moisten  with  mayonnaise  dressing.  Arrange  daintily 
on  lettuce  leaves. 

TOMATO  SALAD 

Take  some  medium  sized  tomatoes,  cover  with  boiling 
water,  remove  skin  and  put  in  refrigerator  until  ready  to 
serve.  Then  cut  off  top  of  tomato,  scoop  out  a  part  of  the 
inside  and  fill  with  finely  cut  celery  mixed  with  boiled  dress- 
ing or  with  mayonnaise.  Serve  tomato  on  lettuce  leaf  and 
garnish  with  sprig  of  parsley. 

WALDORF  SALAD 

Mix  equal  parts  of  apples,  pared  and  cut  into  small  cubes, 
celery  sliced  in  thin  circles  and  English  walnuts  cut  into 


376  VEGETABLE  OR  PLANT  FOODS 


small  pieces.  Season  with  salt  and  moisten  with  mayonnaise. 
Serve  on  lettuce  leaf,  garnished  with  a  spoonful  of  whipped 
cream  and  halves  of  English  walnuts  or  pecans. 

WATER  LILY  SALAD 

One  hard-cooked  egg.  Cut  in  halves  crosswise  in  fence 
fashion;  remove  yolk,  put  through  strainer  and  refill  white. 
Serve  on  shredded  lettuce  leaves  and  garnish  with  parsley. 
Serve  with  French,  boiled  or  mayonnaise  dressing. 

CHEESE  WAFERS 

Butter  wafer  crackers  and  sprinkle  thickly  with  grated 
cheese.  Put  in  oven  and  bake  till  cheese  is  melted  and  crack- 
ers are  a  delicate  brown.  Arrange  on  small  plate  with  doily. 
Serve  with  salad. 

CHEESE  GLUTEN  BISCUIT  CRISPS  (FOR  THE  DIABETIC) 

Put  grated  cheese  on  Gum  Gluten  Biscuit  Crisps,  place  in 
moderate  oven  until  the  cheese  is  melted.  Serve  while  hot. 
Gum  Gluten  Biscuit  Crisps  may  be  spread  with  cream  cheese 
and  served  with  salad. 

FRUITSi 

Fruits  are  the  seed-bearing  portions  of  plants.  Some 
products  of  this  class,  such  as  melons,  are  sometimes  called 
fruits  and  sometimes  vegetables ;  and  a  few  vegetable  products 
which  are  not  fruits  in  the  strict  sense,  are  included  in  this 
class  of  food  products  because  they  have  a  similar  place  in 
the  diet. 

Composition.  Fresh  fruits  contain  a  high  percentage  of 
water,  varying  from  about  75  per  cent,  to  over  95  per  cent. 
It  has  been  suggested  that  those  containing  80  per  cent,  or 
more  of  water  be  classed  as  flavor  fruits,  and  those  with  less 
than  80  per  cent,  as  food  fruits :  Bananas,  grapes  and  fresh 
figs  are  the  commonest  examples  of  the  latter  class.  When 
the  water  is  removed  by  evaporation,  as  in  drying,  the  per- 

^  For  further  information,  note  "  Uses  of  Fruit  as  Food."  Farmer'B  Bulle- 
tin No.  293,  U.  S.  Dept.  of  Agriculture,  Washington,  D.  C. 


FRUITS 


277 


centage  of  moisture  falls  to  30  per  cent,  or  less,  and  the 
proportion  of  nutrients  is  correspondingly  raised,  so  that 
dried  fruits  would  fall  into  the  class  of  food  fruits.  Pre- 
served fruits  have  their  nutritive  value  raised  by  the  addition 
of  water,  and  usually  by  some  loss  of  water  in  preparation. 

As  a  class,  fruits  contain  little  or  no  fat.  The  olive  is  a 
remarkable  exception. 

The  proportion  of  protein  is  so  low  as  to  be  practically 
negligible. 

Carbohydrates  are  the  chief  nutrient  present.  In  ripe 
fruits  these  are  almost  wholly  in  the  form  of  sugars  and  other 
soluble  carbohydrates,  commonly  called  pectin  bodies.  In 
unripe  fruits  starch  is  often  found  —  notably  in  the  ordinary 
banana.  The  principal  sugars  are  sucrose  or  cane  sugar,  dex- 
trose or  grape  sugar,  and  levulose  or  fruit  sugar.  A  mix- 
ture of  the  last  two  is  common,  and  is  called  invert  sugar. 

Fruits  contain  characteristic  organic  acids,  such  as  malic 
in  apples,  citric  in  lemons,  etc.  These  acids  exist  in  the  form 
of  salts,  usually  of  potassium.  A  little  phosphoric  acid,  lime, 
iron,  etc.,  also  occur. 

The  flavor  is  due  partly  to  the  sugars  and  acids,  and  partly 
to  characteristic  ethereal  bodies  present  in  small  quantities. 
Chemists  have  isolated  the  ethers  and  oils  which  give  the 
peculiar  flavor  to  bananas,  strawberries  and  other  fruits. 

Digestibility.  Digestibility  of  fruits  varies  with  the  kind 
of  fruit  eaten  and  its  mode  of  preparation ;  stewed  fruits  are 
more  easily  digested  than  raw  fruits.  Personal  idiosyncracy 
has  also  much  to  do  with  digestibility  in  case  of  this  class 
of  food  materials.  Oranges,  lemons,  grapes  and  peaches  are 
very  generally  digested  with  ease.  Oranges  are  much  used 
in  invalid  dietaries,  their  juice  being  very  effective  in  allay- 
ing thirst.  Orange  juice  is  also  commonly  administered  to 
infants,  especially  if  fed  artificially,  for  the  sake  of  the  min- 
eral matter  and  to  prevent  constipation. 

It  is  important  to  those  who  are  obliged  to  exclude  sugar 
from  the  dietary  to  know  that  fruits  containing  the  least 
sugar  are  the  plum,  peach,  apricot  and  raspberry.  Those 


278 


VEGETABLE  OR  PLANT  FOODS 


containing  the  largest  amounts  are  the  apple^  sweet  cherry, 
grape  and  pear. 

The  apple  exerts  a  most  excellent  influence  upon  the  liver 
and  kidneys^,  and  is  valuable  in  cases  of  acidity  of  the  stom- 
ach. 

The  juice  of  the  ripe  pineapple  contains  a  remarkable  ac- 
tive digestive  principle,  similar  to  pepsin,  termed  bromelin, 
and  so  powerful  is  its  action  upon  proteids  that  it  will  digest 
as  much  as  one  thousand  times  its  weight  within  a  few  hours. 
It  is  especially  valuable  in  -diphtheria  and  diabetes. 

Pigs  and  prunes  are  valuable  for  inactivity  of  the  liver 
and  most  excellent  laxatives. 

The  banana  contains  a  large  amount  of  starch,  as  much  as 
the  potato ;  therefore  it  should  not  be  eaten  in  an  unripe  state. 
For  invalids  and  children  and  others  of  delicate  digestion,  it 
should  always  be  cooked. 

Grape  juice  and  other  freshly  expressed  juices  are  refresh- 
ing and  wholesome  beverages,  and  can  often  be  given  to  in- 
valids when  the  pulp  would  prove  irritating. 

Nutritive  Value,  Fresh  fruits  are  chiefly  valuable  for 
their  refreshing,  appetizing  qualities,  and  for  their  mineral 
constituents.  The  organic  acids  form  carbonates  in  the  body, 
and  by  their  alkalinity  assist  in  the  regulation  of  body 
processes. 

In  disturbed  conditions  of  metabolism  it  is  often  important 
to  know  just  what  salts  and  acids  fruits  contain. 

As  already  stated,  the  chief  nutrients  are  carbohydrates. 
In  fuel  value,  fresh  fruits  resemble  given  vegetables,  as  is 
shown  by  the  following  figures : 


Kind  of  Fresh  Fruit,  Calories 
Per. 
Pound. 

Apples    290 

Blackberries    270 

Oranges    240 

Peaches    190 


Kind  of  Green  Calories 
Vegetables.  Per. 

Pound. 

Beans,  string,  fresh   195 

Beets,  fresh    215 

Carrots,  fresh    210 

Onions,  fresh    205 


FRUITS 


279 


The  dried  fruits  compare  favorably  with  breads  dried  beans 
and  similar  foods  as  to  energy  value,  but  the  latter  contain 
protein  in  considerable  amounts,  while  in  fruits  it  occurs  only 
in  small  quantities.  The  fuel  value  of  fruits  is  often  in- 
creased by  the  sugar  added  in  cooking  or  serving. 

Fruits  are  also  valuable  for  bulk,  which  is  an  essential 
factor  in  diet.  Most  of  them  contain  a  considerable  propor- 
tion of  indigestible  matter.  Intelligently  used,  fruits  are  a 
valuable  part  of  a  well-balanced  diet,  and  their  use  should 
be  encouraged. 

Precautions  in  the  Use  of  Fruit,  Over-ripe  or  unripe  fruit 
should  not  be  eaten  raw;  besides  inferior  flavor  there  is  dan- 
ger of  digestive  disturbance. 

Before  serving,  all  fruit  should  be  thoroughly  washed  to 
avoid  germs.  Digestive  disturbances  are  more  often  caused 
by  these  germs  than  by  the  fruit  itself.  There  is  danger 
also  of  acquiring  harmful  intestinal  parasites  from  raw 
fruits;  in  all  doubtful  cases,  the  food  should  be  cooked. 

BAKED  APPLES 

1  medium  apple  =  70  Calories. 
Wipe  and  core  apples.  Put  in  a  shallow  dish  with  one 
tablespoon  water  to  each  apple;  more  may  be  added  during 
cooking  if  necessary,  put  into  the  center  of  each  apple  two 
teaspoons  sugar.  Bake  in  a  hot  oven  twenty  to  thirty  min- 
utes, or  until  soft;  baste  with  the  syrup  every  ten  minutes. 
A  little  nutmeg  may  be  added  to  the  sugar^  and  a  few  drops 
of  lemon  juice  to  each  apple.  Care  must  be  taken  that  apples 
do  not  lose  their  shape  and  break. 

STEWED  APPLE  SATJCE,  90  CALORIES 

Wash,  pare,  core  and  slice  one  apple;  put  in  saucepan  and 
add  one  teaspoon  sugar  and  enough  boiling  water  to  partly 
cover.  Cover  and  cook  slowly  without  stirring  until  trans- 
parent and  tender.  Appetizing  to  serve  with  any  breakfast 
food. 

Pears  and  peaches  may  be  cooked  in  the  same  way. 


280  VEGETABLE  OR  PLANT  FOODS 


APPLES  CUBAN  STYLE 

Pare  and  core  sound;,  tart  apples.  Steam  until  almost  ten- 
der; remove  to  a  buttered  pan;  fill  cavities  with  cocoanut, 
stick  apples  full  of  blanched  almonds,  baste  with  syrup  made 
of  sugar,  water  and  lemon  juice.  Finish  cooking  in  a  hot 
oven,  basting  often.  When  serving,  fill  the  cavities  with 
jelly  or  the  jellied  juice. 

APRICOT  AND  PRUNE  SAUCE,  178  CALORIES  i 

14  cup  prunes.  '         1  cup  cold  water. 

14  cup  dried  apricots.  Sugar  to  taste. 

Wash  fruit  carefully;  soak  over  night  and  cook  slowly  for 
two  hours.  If  cooked  properly  the  fruit  will  need  very  little 
sugar,  as  the  sugar  in  the  fruit  is  developed  by  this  method 
of  cooking. 

BAKED  BANANA 

1  medium  banana  =  64  Calories. 

Eaw,  this  fruit  is  often  indigestible,  but  baked  it  acts  as 
a  stimulant  to  the  nerves,  being  at  once  received  and  rapidly 
assimilated  by  the  stomach.  Cut  bananas  in  halves;  put  in 
shallow  pan ;  sprinkle  with  sugar  and  a  little  lemon  juice  and 
bake  until  soft. 

Note. —  The  banana  contains  starch  and  should  be  thor- 
oughly ripened  before  eating. 

CRANBERRY  SAUCE  OR  JELLY 

1  cup  cranberries.  %  cup  water. 

1/3  cup  sugar. 

Pick  over  and  wash  cranberries.  Put  in  saucepan  and  add 
sugar  and  water,  bring  to  the  boiling  point  and  boil  fifteen 
minutes.    Strain  and  cool. 

For  jelly  use  one-half  cup  sugar  and  one-quarter  cup  water 
and  after  straining  put  into  molds. 

BAKED  LEMON  OR  ORANGE 

Bake  a  lemon  or  a  sour  orange  in  a  moderate  oven  for 
twenty  minutes.    When  done,  open  at  one  end  and  take  out 

1  Without  sugar. 


FRUITS 


281 


the  inside.  Sweeten  with  sugar  or  molasses.  This  is  excel- 
lent for  hoarseness  and  pressure  on  the  lungs. 

ORANGE  SUNFLOWER 

Wash  the  orange.  Put  a  three-tined  fork  into  the  stem 
end.  Cut  off  each  end  down  to  pulp^  leaving  the  stem  end 
on  fork,  then  pare  off  rind  to  pulp,  cut  out  each  section  and 
place  on  small  plate  in  sunflower  fashion^  the  pieces  of  pulp 
for  petals;  fill  centre  with  granulated  sugar.    Serve  cold. 

Note. —  To  cut  nicely  have  a  large,  firm,  cold  orange  and 
a  sharp  knife. 

ORANGE  NO.  II 

1  medium  orange  =  77  Calories. 

Select  a  large,  firm  orange;  wash,  cut  and  peel  skin  down 
in  eight  parts,  leaving  them  connected  to  stem  end  of  orange 
to  form  the  petals,  folding  them  under  the  pulp.  Separate 
pulp  in  sections  and  put  ice  between  petals  before  serving. 

PINEAPPLE,  131  CALORIES 

1  slice  Hawaiian  pineapple.  1  Maraschino  cherry. 

Serve  pineapple  on  small  tea  plate  with  cherry  in  center. 
To  eat  a  slice  of  pineapple  after  a  meal  is  quite  in  accord- 
ance with  physiological  indications,  as  pineapple  juice  con- 
tains a  remarkable  digestive  principle  similar  to  pepsin.  It 
aids  the  work  of  digestion  in  the  stomach,  also  in  the  intes- 
tinal tract.  The  Hawaiian  Pineapple  comes  in  three  forms  — 
sliced,  crushed  and  grated.  The  sliced  pineapple  is  usually 
served  just  as  it  comes  from  the  can;  the  crushed  and  grated 
are  used  like  apple  sauce  and  also  in  delicious  made  desserts 
and  beverages. 

STEWED  PRUNES 

3  prunes  =  72  Calories. 
Wash  and  look  over  the  prunes,  cover  with  clear  cold  water 
and  allow  to  stand  on  the  back  of  range  over  night.    In  the 
morning  put  the  saucepan  where  they  will  cook  slowly  for 
four  hours. 


282  VEGETABLE  OB  PLANT  FOODS 


Note. —  No  sugar  is  needed  as  prunes  are  18  per  cent, 
and  by  this  manner  of  cooking  are  made  very  sweet.  This 
simmering  process  renders  them  rich  and  juicy,  while  boiling 
toughens  the  skin.    A  little  lemon  juice  is  a  pleasant  addi- 
tion. 

Prunes  are  a  valuable  nutrient,  and  their  use  as  a  laxative 
is  scarcely  second  to  figs. 

STEAMED  RHUBARB,  234  CALORIES  i 

1  cup  rhubarb   (4  oz.).       "  to  l^  cup  sugar. 

Wash  the  rhubarb  and  cut  it  into  inch  pieces  without  re- 
moving the  skin,  as  this  gives  a  pretty  pink  color  to  the  juice. 
Put  it  into  an  agate  double  boiler  without  water  and  steam 
one-half  hour,  or  until  soft.  Do  not  stir,  as  it  breaks  the 
pieces.  Sweeten  to  taste  at  once  on  taking  from  fire.  If 
rhubarb  cooks  a  minute  too  long  —  which  means  after  it  has 
gone  to  pieces  —  it  will  lose  its  delicious  flavor. 

Ehubarb  is  rich  in  oxalic  acid,  which  does  much  to  tone 
the  system. 

STEWED  FIGS,  936  CALORIES 

%  pound  figs.  1  cup  cold  water. 

%  cup  white  sugar.  Juice  %  lemon. 

Wash  figs.  Dissolve  sugar  in  the  water ;  add  figs  and  bring 
slowly  to  boiling  point.  Stew  two  and  one-half  hours ;  when 
tender,  add  lemon  juice. 

Note. —  Cut  figs  in  small  pieces ;  cook  very  slowly  so  as 
not  to  add  more  water. 


DATE  BON  BONS 

1  date   =  20-25  Calories. 

1  walnut  meat   =■  6-8  Calories. 

Put  salted  almonds,  or  fourths  of  English  walnuts  into  the 
inside  of  dates  that  have  been  cut  open  and  stones  removed. 
Boll  in  powdered  or  granulated  sugar  and  serve. 


^  Calculated  with        cup  sugar ;  with  l^  cup  sugar  =  444  calories. 


NUTS 


283 


NUTSi 


Nuts  enter  but  little  into  the  invalid's  dietary,  but  as  more 
attention  is  being  paid  to  means  of  rendering  them  di- 
gestible, a  word  concerning  them  is  not  out  of  place. 

Composition,  The  edible  substance  of  nuts  is  concentrated 
food,  containing  little  water,  and  with  few  exceptions,  much 
fat.  In  general,  nuts  are  also  rich  in  protein.  The  average 
composition  is  as  follows: 


The  only  common  nut  containing  much  carbohydrate  is  the 
chestnut,  which  contains  73  per  cent.  The  pignolia,  peanut, 
butternut,  almond,  beechnut  and  pistachio  contain  over  20 
per  cent,  of  protein.  The  pecan,  brazil  nut,  butternut,  filbert, 
hickory  nut  and  walnut  contain  over  60  per  cent,  of  fat. 

The  ash  content  is  comparatively  high.  Walnuts,  almonds, 
etc.,  are  rich  in  phosphoric  acid. 

Cooking  of  Nuts,  Nuts  are  more  often  eaten  raw  than 
cooked.  But  the  peanut  is  not  considered  palatable  when  raw, 
and  the  chestnut  is  very  indigestible  unless  the  starch  is 
cooked,  when  it  becomes  very  easily  digestible.  Almonds  are 
widely  used  in  confectionery. 

Nuts  may  be  used  as  staple  articles  of  diet,  in  salad,  soups, 
desserts,  etc. 

To  insure  the  best  utilization  of  nuts  they  must  be  thor- 
oughly prepared  for  digestion  by  grinding  or  mastication. 
Nut  butters  offer  much  less  resistance  to  digestion  than  raw 
nuts  hastily  eaten.  On  account  of  the  high  fat  content, 
these  products  must  be  fresh,  or  the  fat  is  likely  to  decompose 
(become  rancid)  and  be  irritating. 

Nut  flours  and  meals  are  made  into  bread  or  porridge. 
Almond  meal  (containing  no  starch  and  very  little  sugar) 
is  often  utilized  as  a  bread  for  diabetics.    The  chestnut  can- 

1  For  further  information,  note  "  Nuts  and  Their  Uses  as  Food,"  Fanner's 
Bulletin  No.  332,  U.  S.  Dept.  of  Agriculture,  Washington,  D.  C. 


Water   

Protein   

Fats   

Carbohydrates 


1-  4% 
6-15% 
40-50% 
6-10% 


284  VEGETABLE  OR  PLANT  FOODS 


not  be  so  used^  on  account  of  its  high  content  of  starch.  The 
peanut  contains  about  11  per  cent*  of  carbohydrates,  and 
hence  is  undesirable  for  this  purpose. 

Digestibility,  Nuts  have  been  considered  very  indigestible. 
This  is  due  largely  to  improper  mastication  or  other  prepara- 
tion for  digestion;  to  the  fact  that  they  are  a  very  concen- 
trated food,  and  are  often  eaten  when  not  needed.  While 
nut  protein,  as  nuts  are  ordinarily  eaten,  is  not  so  easily  nor 
completely  digested  as  meat  protein,  there  are  experiments 
showing  that  on  the  whole,  they  are  as  thoroughly  digested 
as  an  ordinary  mixed  diet.  'No  experiments  have  been  re- 
ported on  the  ease  or  rapidity  of  nut  digestion. 

Nutritive  Value.  Nuts  are  a  concentrated  food.  This  is 
clearly  shown  by  the  following  figures : 

1  lb.  of  Almonds    yield  2895  Calories. 

1  lb.  of  Brazil  nuts    yield  3120  Calories. 

1  lb.  of  Filberts    yield  3100  Calories. 

1  lb.  of  Hickory    yield  3345  Calories. 

1  lb.  of  Peanuts    yield  2610  Calories. 

1  lb.  of  Walnuts    yield  3075  Calories. 

The  high  fuel  value  is  due  to  the  absence  of  water  and  the 
large  amount  of  fat  present.  Nuts  can  be  most  advan- 
tageously used  along  with  bulky  foods,  such  as  fruits  and 
vegetables,  and  those  lacking  in  fat,  such  as  bread.  In  a 
vegetarian  diet  they  become  a  valuable  source  of  protein. 

FUNGI  AND  ALG2E 

These  substances  have  little  nutritive  value.  They  may  be 
considered  as  food  adjuncts,  rather  than  foods  proper. 

Of  fungi,  mushrooms  are  the  most  commonly  eaten.  They 
are  prized  for  their  delicate  flavor.  Chemical  analysis  shows 
a  high  percentage  of  nitrogen,  but  although  reported  as  pro- 
tein, it  is  largely  in  an  indigestible  form. 

Algae  and  lichens  are  much  used  as  food  in  some  parts  of 
the  world  and  high  claims  are  sometimes  made  for  their 
nutritive  value,  but  digestion  experiments  show  that,  although 


FUNGI  AND  ALG^ 


285 


they  have  a  similar  carbohydrate  content  to  other  succulent 
vegetable  foods^  these  carbohydrates  are  not  attacked  by  the 
ordinary  digestive  enzymes  of  the  alimentary  tract. 

The  most  important  alga,  from  the  dietetic  standpoint,  is 
Irish  moss.  It  is  commonly  used  in  making  jellies  or  sooth- 
ing beverages  for  invalids,  but  it  has  no  nutritive  value 
whatsoever. 

The  lichen  most  used  as  food  is  Iceland  moss.  It  has 
frequently  been  recommended  as  a  food  for  diebetics,  but  it 
is  practically  indigestible. 


CHAPTER  XI 


NUTRITIOUS  DESSERTS 

HOT  AND  COLD  DESSERTS  —  FROZEN  DESSERTS 

SOFT  CUSTARDS,  BAKED  CUSTARDS,  WHIPS  AND  SOUFFLES, 
JUNKET,  CORNSTARCH  PUDDINGS  OR  BLANC  MANGE,  RICE, 
TAPIOCA,  CRACKER  AND  BREAD  PUDDINGS,  SAUCES 

Properly  prepared^  the  dessert  may  constitute  a  very  large 
part  of  the  nutriment  represented  in  a  meal.  Dishes  con- 
taining eggs^  milk^  cream^  starches^  etc.,  in  large  proportion 
are  necessarily  of  high  nutritive  value,  and  become  a  useful 
means  of  administering  these  foods  to  patients  who  do  not 
care  for  the  flavor  of  plain  milk,  raw  eggs,  cereals,  etc.,  or 
who  are  likely  to  become  tired  of  them.  For  invalids,  com- 
binations of  foods  should  always  be  simple,  because  the  more 
complex  the  mixture  of  protein,  fat  and  carbohydrate,  the 
longer  and  more  complicated  is  the  process  of  digestion. 
Hence  junket,  which  is  simply  flavored,  coagulated  milk,  is 
one  of  the  most  digestible  of  desserts.  As  a  rule,  less  sugar 
is  relished  in  sickness  than  in  health;  an  excess  is  apt  to 
cause  nausea. 

Dainty  service  is  most  important.  Baked  custards  and 
junkets  are  usually  best  served  in  the  original  individual 
molds  to  avoid  danger  of  breaking,  or  in  case  of  junket,  of 
becoming  watery.  Sauces  should  never  be  poured  over  pud- 
dings till  the  moment  of  serving.  Care  must  be  taken  to 
see  that  cold  desserts  are  thoroughly  chilled;  a  lukewarm 
custard  is  frequently  nauseating  and  always  unappetizing. 


286 


SOFT  CUSTARDS 


287 


SOFT  CUSTARDS 

SOFT  CUSTARD  NO.  I,  192  CALORIES 

(Individual  Rule.) 

Yolk  1  egg.  Speck  salt. 

1  tablespoon  sugar.  cup  milk. 

Scald  milk  in  double  boiler.  Beat  yolk,  add  salt  and  sugar 
and  pour  on  gradually  the  scalded  milk.  Pour  back  into 
top  of  double  boiler  and  stir  constantly  until  it  looks  creamy 
or  it  coats  the  spoon  and  the  foam  has  disappeared;  then  re- 
move immediately  from  hot  water.  Cool  and  add  flavoring 
desired;  vanilla^  orange  or  lemon  extract. 

Xote. —  If  custard  curdles,  place  saucepan  over  cold  water 
and  beat  until  smooth. 

This  custard  is  usually  used  for  pudding  sauces. 

SOFT  CUSTARD  NO.  II,  410  CALORIES 

(Two  Servings.) 

1  cup  milk.  %  saltspoon  salt. 

2  eggs.  %  teaspoon  vanilla  or  grating  of 
2  tablespoons  sugar.  nutmeg. 

Eeserve  one  egg  white  for  meringue.  Blend  according  to 
Soft  Custard  No.  I.  This  custard  is  usually  used  as  a' 
foundation  for  puddings. 

CUSTARD  SUITABLE  FOR  A  DIABETIC,  230  CALORIES 

(Two  Servings.) 
1  egg.  Speck  salt. 

Sweetina  to  taste.  1  cup  milk. 

Scald  the  milk  and  add  the  liquid  Sweetina  to  taste;  pour 
on  to  the  well-beaten  eggs.  Cook  and  flavor  as  in  preceding 
rule  for  soft  custard  or  bake  according  to  Cup  Custard. 

MERINGUE,  110  CALORIES  1 

1  egg  white.  2  tablespoons  powdered  sugar. 

Speck  salt.  Lemon  or  orange  juice. 

Beat  the  egg  until  stiff  and  dry;  add  the  salt,  sugar  and 
lemon  juice  to  taste.    Beat  very  little  after  adding  the  sugar. 

^  Without  lemon  and  orange  juice. 


388 


NUTRITIOUS  DESSERTS 


FLOATING  ISLAND,  506  CALOEIES 

Chill  Soft  Custard  No.  II;  pour  into  serving  dish  and  put 
meringue  on  top. 

ORANGE  CUSTARD 

Peel,  slice  and  remove  seeds  of  oranges,  put  into  serving 
dish.  Chill  Soft  Custard  No.  II,  pour  over  fruit  and  put 
meringue  on  top. 

BANANA  CUSTARD 

Peel  bananas  and  slice  very  thin  with  silver  knife;  put 
into  serving  dish  and  flavor  with  lemon  juice.  Chill  Soft 
Custard  No.  II,  pour  over  fruit  and  put  meringue  on  top. 

ALMOND  PUDDING 

Line  a  glass  dish  with  slices  of  stale  cake  and  put  in  some 
salted  almonds.  Pour  a  little  sherry  wine  on  the  cake.  Chill 
Soft  Custard  No.  II  and  pour  over.  Put  meringue  on  top, 
with  some  salted  almonds  in  it. 

PEACH  CUSTARD 

Put  into  serving  dish  alternate  layers  of  stale  cake  and 
slices  of  fresh  or  canned  peaches.  Chill  Soft  Custard  No.  II, 
pour  over  fruit  and  put  meringue  on  top. 

APPLE  CUSTARD 

Cool  baked  apples  and  put  in  serving  dish.  Heap  meringue 
on  top  and  brown  slightly  in  the  oven.  Serve  with  Soft 
Custard  No.  I. 

BAKED  CUSTARDS 

BAKED  OR  CUP  CUSTARD,  319  CALORIES 

(Individual  Rule.) 
1  cup  milk.  1%  tablespoon  sugar. 

1  egg.  %  saltspoon  salt. 

Flavoring  to  taste  —  nutmeg,  cinnamon,  vanilla,  or  lemon  extract. 

Scald  the  milk;  beat  egg,  add  sugar  and  salt  and  pour  on 
gradually  the  scalded  milk.  Flavor  to  taste  and  pour  into 
custard  cups;  place  in  deep  pan  and  pour  boiling  water 


BAKED  CUSTARDS 


289 


around  until  it  almost  reaches  the  top  of  cups.  Bake  in 
moderate  oven  about  twenty  minutes.  If  cinnamon  is  used 
for  flavor^  put  one-half  square  inch  into  the  milk  when  scald- 
ing. 

l^ote. —  To  test  when  done,  dip  a  pointed  knife  into  water 
and  plunge  into  the  middle  of  the  custard.  If  it  looks  set 
and  the  knife  comes  out  clear,  the  custard  is  done;  if  milky, 
it  is  not  cooked  enough.  If  cooked  too  long  the  custard  will 
curdle. 

BAKED  CUSTARD  NO.  II,  262  CALORIES 

(Individual  Rule.) 
2/3  cup  milk.  1/3  saltspoon  salt. 

1  egg.  Nutmeg. 
lYz  tablespoon  sugar.  14  teaspoon  vanilla. 

Blend  according  to  Baked  Custard  No.  I. 

The  smaller  quantity  of  milk  makes  a  little  firmer  custard. 

WHITE  CUSTARD,  163  CALORIES 

1  egg  white.  l^  saltspoon  salt. 

1  tablespoon  sugar.  l^  cup  rich  milk. 

Beat  white  of  egg  until  very  light;  add  sugar  and  salt 
and  pour  on  gradually  the  milk.  Flavor  with  vanilla,  orange 
or  lemon  extract.  Bake  in  cups  set  in  pan  of  boiling  water 
in  a  moderate  oven  about  twenty  minutes.  When  firm  set 
on  ice  and  serve  cold.  This  may  be  taken  by  patient  when  the 
yolk  of  egg  is  prohibited. 

CHOCOLATE  CUSTARD,  250  CALORIES 

(Individual  Rule.) 

2  teaspoons  Walter  Baker's  choc-  2  egg  yolks, 
olate.  2  teaspoons  sugar. 

2  tablespoons  milk.  Speck  salt. 

6  tablespoons  rich  milk. 

Grate  chocolate  and  mix  with  the  two  tablespoons  milk; 
stir  over  the  fire  until  smooth,  add  the  rich  milk,  the  well- 
beaten  egg  yolks,  sugar  and  salt.  Pour  into  custard  cups  set 
in  pan  of  hot  water  (nearly  to  the  top).  Cook  until  custard 
is  set.    Serve  hot  or  cold. 


290 


NUTRITIOUS  DESSERTS 


Note. —  The  chocolate  and  yolk  of  egg  contain  a  large 
amount  of  fat.  Do  not  serve  to  a  patient  who  cannot  digest 
it. 

MALTED  MILK  CUSTARD,   107  CALORIES 

(Individual  Rule.) 
1    tablespoon   Horliek's   Malted   %  cup  hot  water. 

Milk.  Salt. 
1  egg  yolk. 

Mix  the  Malted  Milk  powder  with  enough  of  the  hot 
water  to  make  a  smooth  paste^  add  remainder  of  water  and 
pour  it  gradually  on  to  the  well-beaten  yolk.  Butter  custard 
cup^  pour  in  the  mixture  and  let  it  stand  in  a  pan  of  boil- 
ing water  in  a  moderate  oven  until  custard  is  set. 

BAKED  CARAMEL  CUSTARD,  293  CALORIES 

(Individual  Rule.) 
%  cup  milk.  2  tablespoons  sugar. 

1  egg.  A  few  drops  of  vanilla. 
Speck  salt. 

Scald  the  milk.  Put  the  sugar  in  a  small  saucepan^  place 
over  heat  and  stir  constantly  until  the  sugar  is  melted  and 
a  light  brown  color.  Add  milk  and  pour  over  the  slightly- 
beaten  egg.  Add  flavoring.  Strain  into  buttered  custard 
cups^  place  in  a  pan  of  hot  water  and  bake  until  firm  in  a 
slow  oven. 

PEPTONOIDS  CUSTARD,  452  CALORIES 

2  tablespoons  of  Dry  Peptonoids  Yolks  of  2  eggs. 
Soluble.  2  teaspoons  of  sugar. 

2  tablespoons  of  milk.  A  pinch  of  salt. 

6  tablespoons  of  thin  cream. 

Dissolve  Dry  Peptonoids  Soluble  in  the  milk.  Add  the 
well-beaten  egg  yolkS;,  sugar  and  salt.  Pour  into  custard 
cups^  set  in  pan  of  hot  water^  cook  until  set. 

WHIPS  AND  SOUFFLES 

Dainty  and  nutritious  ways  to  serve  the  uncooked  and 
slightly  cooked  white  of  eggs. 


WHIPS  AND  SOUFFLES 


291 


FRUIT  WHIP,  125-150  CALORIES 

(Two  Servings.) 

Any  fruity  fresh;,  canned  or  dried  (properly  prepared),  or 
jellies  may  be  used. 

2  to  4  tablespoons  fruit  pulp.  2  tablespoons  powdered  sugar 
White  1  egg.  (or  to  taste). 

Lemon  juice. 

Prepare  the  fruit  pulp  by  scraping,  grating  or  rubbing 
through  a  strainer.  Beat  the  white  of  egg  on  platter  until 
stiff.  Add  pulp,  sugar  and  lemon  juice  to  taste,  and  beat 
until  very  stiff.  Heap  in  center  of  serving  dish  and  pour 
Soft  Custard  Is  o.  I  around  it. 

Note. —  The  apple  is  a  favorite  fruit  for  these  whips. 
The  juice  of  fresh  fruits  in  season  used  w^ith  the  raw  white 
of  egg  makes  an  appetizing  as  well  as  a  very  nutritious  lunch 
for  the  sick. 

STRAWBERRY  WHIP,  327  CALORIES 

(Four  Servings.) 
1  cup  fresh  strawberries.  %  cup  powdered  sugar. 

Whites  2  eggs. 

Wash  and  hull  the  strawberries  and  mash  slightly.  Beat 
whites  of  eggs  until  stiff,  add  sugar  and  berries;  beat  until 
very  stiff,  using  a  broad  bowl  and  a  wire  egg-beater,  beating 
with  a  long,  steady  stroke.  Pile  lightly  in  a  glass  dish  and 
serve  with  white  or  sponge  cake. 

GRAPE  WHIP,  1445  CALORIES 

(Six  Servings.) 
%  cup  Welch's  grape  juice.  5  tablespoons  sugar. 

White  1  egg.  1  cup  double  cream. 

Beat  the  white  of  egg  until  foamy,  add  the  grape  juice 
mixed  with  the  sugar  and,  lastly,  the  cream,  then  beat  with 
a  whip  churn.  Take  off  the  froth  as  it  rises  and  drain  on 
a  sieve.  Pour  the  unwhipped  mixture  into  small,  high  glasses 
and  pile  the  whip  on  top.    Serve  cold. 


392 


NUTRITIOUS  DESSERTS 


OMELET  SOUFFLE,  230  CALORIES  i 

(Individual  Rule.) 
Yolk  1  egg.  Speck  salt. 

3  tablespoons  powdered  sugar.      Whites  2  eggs. 
2  tablespoons  lemon  juice.  Strawberry  or  fruit  jam. 

To  the  well-beaten  yolk  add  the  sugar^  salt,  lemon  juice 
and  rind.  Beat  the  whites  to  the  stiffest  possible  froth,  then 
cut  and  fold  into  the  yolk.  Have  ready  a  small  baking  dish, 
buttered  and  spread  with  a  layer  of  the  fruit ;  pour  the  omelet 
over  it  and  bake  in  a  moderate  oven  fifteen  or  twenty  min- 
utes.   Test  as  for  baked  custard.    Serve  at  once. 

Note. —  Do  not  use  lemon  rind  if  it  will  interfere  me- 
.dicinally. 

CTTSTARD  SOUFFLE,  297  CALORIES 

(Individual  Rule.) 
%  tablespoon  butter.  Yolk  1  egg. 

ll^  tablespoons  flour.  1^4  tablespoons  sugar. 

%  cup  scalded  milk.  White  1  egg. 

Melt  butter,  add  flour  and  gradually  the  scalding  milk. 
'Cook  thoroughly,  pour  on  to  the  well-beaten  yolk,  add  sugar 
.and  cool.  Fold  into  mixture  the  well-beaten  white.  Turn 
into  buttered  custard  cups  and  bake  about  fifteen  minutes, 
until  firm  —  determined  by  pressing  with  the  finger.  Take 
from  oven  and  serve  at  once,  or  it  will  fall.  Serve  with 
Foamy  Sauce. 

LEMON  SOUFFLE,  275  CALORIES 

(Individual  Rule.) 
Yolk  1  egg.  i/i  cup  sugar. 

Juice  14  lemon.  White  1  egg. 

Thoroughly  beat  yolk,  add  sugar,  slowly,  beating  con- 
;stantly;  add  lemon  Juice.  Fold  in  the  white  beaten  until 
dry.  Pour  into  buttered  custard  cups,  set  in  pan  of  hot 
water  and  bake  twenty  minutes  or  until  firm,  testing  by  press- 
ing with  finger.    Serve  plain  or  with  Foamy  Sauce. 

^  Without  jam. 


JUNKET 


293 


PEACH  MERINGUE,  210  CALORIES  i 

(Individual  Rule.) 
1  cup  yellow  peaches.  Bread  crumbs. 

Sugar  to  taste.  White  1  egg. 

Yolk  1  egg.  1  tablespoon  powdered  sugar. 

Stew  peaches  in  a  very  little  water^  sweeten  to  taste  and 
stir  in  the  well-beaten  yolk.  Butter  a  pudding  dish  and 
cover  bottom  with  fine  bread  crumbs^  put  in  the  peaches  and 
bake  fifteen  minutes.  Cover  with  meringue  made  of  white 
of  egg  and  the  powdered  sugar;  brown  slightly  in  the  oven. 
Serve  cold. 

JUNKET 

Junket  is  a  healthful  and  dainty  dessert  made  simply  of 
pure  milk^  and  containing  enough  of  the  active  principle 
of  rennet  found  in  the  Junket  Tablet  to  coagulate  the  milk. 
It  is  nutritious  and  has  the  added  advantage  of  being  easily 
digested. 

Milk  or  cream  that  has  been  boiled,  sterilized^  condensed 
or  evaporated  cannot  be  used  in  making  junket,  and  care 
must  be  taken  not  to  heat  the  milk  more  than  lukewarm,  as 
hot  milk  spoils  the  action  of  the  tablet. 

For  diabetic  patients  Sweetina  may  be  used  as  a  substitute 
for  sugar  in  these  recipes. 

PLAIN  JUNKET,  296  CALORIES 

(Individual  Rule.) 

1  cup  milk.  1/4  Hansen's  Junket  Tablet. 

2  tablespoons  sugar.  1  teaspoon  cold  water. 

teaspoon  brandy  or  wine. 

Heat  the  milk  until  lukewarm,  add  sugar  and  flavoring; 
when  sugar  is  dissolved  add  the  tablet  dissolved  in  the  cold 
water.  Pour  mixture  immediately  into  sherbet  cups  or  cham- 
pagne glasses,  partly  fill.  Stand  in  warm  room  undisturbed 
until  firm  like  jelly,  then  put  on  ice  to  cool.  Serve  with 
whipped  cream  heaped  on  top,  with  one-half  teaspoon  bright 
jelly  for  garnish. 

^  Without  bread  crumbs  and  sugar. 


294  NUTRITIOUS  DESSERTS 


Note. —  For  variety^  whole  strawberries  or  raspberries  may 
be  served  with  junket,  or  chopped  English  walnuts  with  the 
whipped  cream.    For  garnish,  candied  cherries  may  be  used. 

If  desired,  the  brandy  and  sugar  may  be  omitted  in  making 
junket  and  served  plain,  with  sugar  and  a  grating  of  nutmeg. 

CUSTARD  JUNKET,  512  CALORIES 

(Two  Servings.) 
14  cup  hot  milk.  2  tablespoons  sugar. 

1  egg.  l^  teaspoon  vanilla. 

2  tablespoons  sugar.  %  Hansen's  Junket  Tablet. 
%  cup  lukewarm  milk.      •           2  teaspoons  cold  water. 

Beat  the  egg,  add  two  tablespoons  sugar;  pour  on  grad- 
ually the  hot  milk.  Cook  in  top  of  double  boiler;  stir  con- 
stantly until  it  thickens;  take  at  once  from  the  fire  and  cool. 
Mix  two  tablespoons  sugar  with  the  lukewarm  milk,  add  to 
the  cooled  custard  and  blend  thoroughly.  ^Vhen  lukewarm 
add  vanilla  and  the  tablet  dissolved  in  cold  water;  finish  as 
for  Plain  Junket. 

COCOA  JUNKET,  280  CALORIES 

(Individual  Rule.) 

1  tablespoon  cocoa.  14  Hansen's  Junket  Tablet. 

2  teaspoons  sugar.  1  teaspoon  cold  water. 
2  tablespoons  boiling  water.          3  drops  vanilla. 

1  cup  milk. 

Mix  the  cocoa,  sugar,  boiling  water,  and  cook  over  heat 
and  rub  to  a  smooth  paste;  add  gradually  the  fresh  cool 
milk.  Heat  until  lukewarm  (not  more),  add  vanilla  and 
then  tablet  dissolved  in  the  cold  water.  Finish  as  for  Plain 
Junket  and  serve  with  sweetened  cream  or  a  Soft  Custard. 

COFFEE  JUNKET,  289  CALORIES 

(Individual  Rule.) 

2  tablespoons  boiled  coffee.  %  Hansen's  Junket  Tablet. 

1  scant  cup  milk.  1  teaspoon  cold  water. 

2  tablespoons  sugar. 

Heat  the  milk  until  lukewarm,  add  the  coffee  and  sugar; 
when  sugar  is  dissolved  add  the  tablet  dissolved  in  the  cold 
water.    Finish  as  for  Plain  Junket. 


CORNSTARCH  PUDDING  OR  BLANC  MANGE  295 


CORNSTARCH  PUDDING  OR  BLANC  MANGE 

Starch  of  various  kinds  is  used  in  milk  puddings.  For 
children,  invalids  and  dyspeptics  such  puddings  are  admirable. 
They  must  be  thoroughly  cooked,  that  the  action  of  the  heat 
may  aflEect  the  starch.  The  combination  of  starch  and  milk 
gives  a  wholesome  nutritive  food,  and  the  addition  of  eggs 
increases  the  food  value. 

CORNSTARCH  PUDDING,  329  CALORIES 

(Individual  Rule.) 
1  cup  milk.  Speck  salt, 

li/o  tablespoons  cornstarch.  White  1  egg, 

ll^  tablespoons  sugar.  Vanilla. 

Scald  the  milk  in  double  boiler.  Mix  cornstarch,  sugar 
and  salt  thoroughly;  add  slowly  the  scalded  milk,  stirring 
constantly.  Eeturn  to  top  of  boiler  and  cook  twenty  min- 
utes, stirring  constantly  for  the  first  five  or  six  minutes,  then 
occasionally.  Remove  from  fire  and  while  very  hot  fold  in 
lightly,  but  thoroughly,  the  well-beaten  white  of  egg.  When 
partially  cooled  add  fiavoring  to  taste;  put  into  wet  cups 
or  molds,  cool  and  then  stand  for  several  hours  on  ice.  Re- 
move from  molds.  Serve  with  a  soft  custard,  mashed  fresh 
berries,  or  whipped  cream.  Vary  the  pudding  by  adding  a 
little  Walter  Baker's  chocolate,  melted. 

PINEAPPLE  CREAM,  340  CALORIES 

(Individual  Rule.) 
1  cup  milk.  Speck  salt. 

1^2  tablespoons  cornstarch.  White  1  egg. 

11/2  tablespoons  sugar.  2  tablespoons  grated  pineapple. 

Follow  directions  for  Cornstarch  Pudding,  adding  the 
pineapple  instead  of  vanilla.  Pour  into  individual  molds 
and  serve  cold  with  cream. 

CORNSTARCH  FRUIT  JELLY,  166  CALORIES  i 

(Two  Servings.) 
1  cup  raspberry  juice.  2  tablespoons  cornstarch. 

Sugar. 

^  Without  sugar. 


896 


NUTRITIOUS  DESSERTS 


Sweeten  the  juice  to  taste  and  heat  to  boiling  point.  Make 
a  smooth  paste  of  the  cornstarch  and  a  little  cold  water,  add 
slowly  to  the  juice  and  cook  thirty  minutes  in  top  of  double 
boiler,  stirring  constantly  at  first.  Pour  into  cold,  wet  molds. 
Serve  cold  with  whipped  cream  and  fresh,  whole  berries. 

MALTED  MILK  BLANC  MANGE,  280  CALOEIES 

(Two  Servings.) 
2  tablespoons  Horlick's  Malted     Speck  salt. 

Milk.  1  tablespoon  sugar. 

2  tablespoons  powdered  arrow-      IV2  cups  boiling  water, 
root.  14  teaspoon  vanilla. 

Mix  the  arrowroot  and  Malted  Milk  powder  with  a  little 
cold  water  into  a  smooth  paste.  Add  the  boiling  water  slowly, 
cook  in  double  boiler  about  twenty  minutes,  or  until  arrow- 
root is  thoroughly  cooked,  add  vanilla  and  pour  into  cold, 
wet  molds.  Chill  and  serve  with  Soft  Custard  or  whipped 
cream. 

Note. —  One  teaspoon  powdered  coffee  may  be  added  to 
above  before  cooking,  for  Coffee  Blanc  Mange. 

NUTRITIOTTS  WHEAT  PUDDING,  252  CALORIES 

(Individual  Rule.) 
1  cup  milk.  White  1  egg. 

214  tablespoons  flour.  %  teaspoon  vanilla. 

Speck  salt. 

Blend  flour  with  a  little  of  the  cold  milk.  Scald  remainder 
of  milk  and  add  flour  mixture;  cook  thoroughly;  add  salt 
and  flavoring  and  fold  in  the  white  of  egg  beaten  slightly. 
Put  into  cold,  wet  mold,  cool  and  set  in  ice  box  to  harden. 
Serve  with  Soft  Custard  or  whipped  cream,  or  sprinkle  with 
powdered  sugar  and  pour  over  it  one-fourth  cup  of  fresh 
fruit  juice  or  crushed  fruit. 

GLUTEN  PUDDING  (FOR  THE  DIABETIC),  861  CALORIES 

(Six  Servings.) 

3  tablespoons  Gum  Gluten  Flour.   1  teaspoon  butter. 
1  pint  hot  milk.  1  saltspoon  salt. 

1  pint  cold  milk.  Cinnamon. 
1  egg.  Sweetina. 


mCE  PUDDINGS 


297 


Blend  Gum  Gluten  Flour  with  a  little  of  the  cold  milk, 
add  gradually  to  one  pint  hot  milk.  Cook  thoroughly.  Beat 
eggy  add  cold  milk,  the  cooked  mixture  and  salt,  cinnamon 
and  Sweetina  to  taste.  Bake  thirty  minutes.  A  little  fruit 
improves  the  flavor.    Serve  with  whipped  cream. 

IRISH  MOSS  JELLY,  677  CALORIES 

(Three  Servings.) 
cup  Irish  moss.  Juice  1  lemon  or  orange. 

2  cups  boiling  water.  1/3  cup  sugar. 

4  figs. 

Soak,  pick  over  and  wash  the  moss.  Put  it  into  the  boil- 
ing water,  add  the  figs  cut  into  strips  and  simmer  about 
twenty  minutes,  or  until  it  is  very  thick  when  dropped  on 
a  cold  plate.  Add  lemon  juice  and  sugar.  Strain  into  a 
cold,  wet  mold. 

IRISH  MOSS  BLANC  MANGE,  296  CALORIES 

(Four  Servings.) 
%  cup  Irish  moss.  l^  saltspoon  salt. 

11/2  cups  cold  water.  1/3  teaspoon  vanilla. 

1%  cups  milk. 

Soak  the  moss  in  cold  water  about  fifteen  minutes.  Ee- 
move  from  water,  pick  over  and  put  into  double  boiler  with 
the  milk.  Cook  about  twenty  minutes,  or  until  it  thickens- 
when  dropped  on  a  cold  plate.  Add  salt,  strain  and  flavor. 
Strain  again  and  turn  into  small  cold,  wet  molds.  Chill  and 
serve  with  cream  and  sugar  or  sliced  fruit. 

RICE  PUDDINGS 

BOILED  RICE,  100  CALORIES 

(Individual  Rule.) 
2  tablespoons  rice.  l^  teaspoon  salt. 

2  cups  boiling  water. 

Wash  rice  thoroughly  and  add  gradually  to  the  boiling 
salted  water,  care  being  taken  that  the  water  does  not  stop 
boiling.    Boil  uncovered  twenty  minutes,  or  until  grains 


S98 


NUTRITIOUS  DESSERTS 


are  soft.  Turn  into  a  strainer  and  pour  over  it  one  cup  of 
hot  water  and  drain,  put  in  oven  a  few  moments  to  dry,  with 
oven  door  open.  Serve  as  a  cereal  with  sugar  or  cream  or 
as  a  pudding  with  cooked  dates  and  whipped  cream,  or  plain 
with  Soft  Custard. 

Note. —  Keep  rice  well  covered  with  water  while  cooking. 

Dates. —  Cut  in  small  pieces,  add  a  little  water  to  partly 
cover  and  cook  until  soft.    Simmer  and  do  not  stir. 

STEAMED  RICE,  265  CALORIES 

(Individual  Rule.) 
1/3  cup  rice.  1/2  teaspoon  salt. 

1  cup  boiling  water. 

Pick  over  the  rice,  wash  in  three  or  four  waters;  put  it 
with  the  boiling  water  and  salt  in  upper  part  of  double 
boiler.  Do  not  stir  while  cooking.  Steam  one  hour,  or  until 
the  grains  are  tender.  Serve  as  a  cereal  with  sugar  or  cream 
or  as  a  pudding  with  Soft  Custard,  or  with  sugar  and  cream. 

Note. —  A  few  dates  cut  in  narrow  strips  may  be  added 
just  before  serving  if  desired.  Part  milk  may  be  used  in 
the  cooking. 

PEACHES  AND  RICE 

Serve  boiled  or  steamed  rice  with  sections  of  fresh,  juicy 
peaches,  or  with  fresh  berries.    Serve  with  sugar  and  cream. 

SOUTHERN  SNOWBALLS,  367  CALORIES 

(Individual  Rule.) 
^^  cup  rice.  Vi  teaspoon  salt. 

1  cup  milk. 

Pick  over  rice,  wash  in  several  waters  and  put  with  milk 
and  salt  in  top  of  double  boiler.  Cook  until  the  milk  is  ab- 
sorbed and  rice  is  tender.  Do  not  stir  while  cooking.  Dip 
egg  cups  in  cold  water  and  pack  with  rice  carefully  but 
tightly^  turn  out  on  serving  dish,  sprinkle  with  powdered 
sugar,  put  a  candied  cherry  or  a  strawberry  on  top,  and  serve 
with  whipped  cream. 


EICE  PUDDINGS 


299 


PLAIN  RICE  PUDDING,  746  CALORIES 

(Individual  Rule.) 
1  cup  steamed  rice.  2  tablespoons  sugar. 

1  cup  scalded  milk.  l^  saltspoon  salt. 

%  tablespoon  butter.  l^  cup  stoned  raisins. 

1  egg. 

Scald  milk  and  add  butter.  Beat  egg,  add  sugar  and  salt 
and  pour  on  slowly  the  scalding  milk.  Put  in  pudding  dish 
with  rice  and  raisins.  Bake  in  a  moderate  oven  until  custard 
is  set.    Serve  with  Hard  Sauce. 

Note. —  Do  not  use  raisins  in  case  of  bowel  trouble. 

RICE  MERINGUE,  526  CALORIES 

(Two  Servings.) 
cup  cold  cooked  rice.  Egg  yolk. 

1  cup  scalded  milk.  Vanilla. 

2l^  tablespoons  sugar.  1  egg  white. 

Y2  saltspoon  salt.  2  tablespoons  powdered  sugar. 

Blend  rice  and  milk  and  soak  until  soft.  Beat  the  yolk, 
add  sugar  and  salt  and  gradually  the  hot  milk  and  rice. 
Cook  until  it  thickens  like  soft  custard.  Add  flavoring  to 
taste  and  pour  into  pudding  dish  or  custard  cups.  Make  a 
meringue  of  the  white  of  egg  and  powdered  sugar^  cover  the 
pudding  and  brown  slightly  in  the  oven. 

CREAM  OF  RICE  PUDDING,  657  CALORIES 

(Three  Servings.) 
14  cup  rice  (well  washed).  1  saltspoon  salt. 

2  tablespoons  sugar.  1  pint  milk. 

Mix  all  ingredients  in  a  small  baking  dish.  Bake  two 
hours,  slowly  at  first  until  rice  is  softened  and  thickened  in 
the  milk.  Cut  the  crust  several  times^  stirring  to  the  bottom 
gently.  The  crust  will  then  dissolve  in  the  pudding,  giving 
it  a  creamy  color.    Then  let  it  brown  slightly. 


300 


NUTRITIOUS  DESSERTS 


TAPIOCA  PUDDINGS 

TAPIOCA  CREAM,  483  CALORIES 

(Two  Servings.) 
ll^  tablespoons  Minute  tapioca.     1  cup  scalded  milk. 
3  tablespoons  sugar.  1  egg. 

l^  saltspoon  salt.  Flavoring. 

Scald  milk  in  double  boiler.  Mix  tapioca,  sugar  and  salt; 
add  slowly  to  the  scalding  milk,  return  to  double  boiler  and 
cook  fifteen  minutes.  Add  the  yolk  and  white  of  the  egg, 
beaten  separately.  Eemove  from  fire  and  add  flavoring  de- 
sired.   Serve  plain  or  with  any  fresh  fruit  in  season. 

PLAIN  TAPIOCA,  451  CALORIES 

(Three  Servings.) 
1^4  tablespoons  Minute  tapioca.    1  cup  scalded  milk. 
2  tablespoons  sugar.  ^^  cup  raisins. 

Salt.  Nutmeg. 

Scald  milk  in  double  boiler  and  gradually  add  the  tapioca 
and  sugar.  Cook  fifteen  minutes.  Add  salt,  nutmeg  to  taste 
and  seeded  raisins.    Serve  with  cream  and  sugar. 

Note. —  Eaisins  should  never  be  used  in  bowel  trouble. 

PINEAPPLE  TAPIOCA,  718  CALORIES 

(Three  Servings.) 
14  cup  Minute  tapioca.  1%  cups  boiling  water. 

14  cup  sugar.  1  cup  canned  grated  pineapple. 

Speck  salt. 

Mix  tapioca,  sugar  and  salt,  pour  on  slowly  the  boiling 
water  and  cook  in  double  boiler  until  clear,  about  fifteen  min- 
utes. Pour  over  the  grated  pineapple  and  decorate  the  top 
of  the  pudding  with  currant  jelly. 

APPLE  TAPIOCA,  345  CALORIES  1 

(Three  Servings.) 
14  cup  Minute  tapioca.  1  pint  boiling  water. 

1  tablespoon  sugar.  3  tart  apples. 

Speck  salt.  Sugar,  nutmeg. 

^  Without  extra  sugar. 


TAPIOCA  PUDDINGS 


301 


Mix  tapioca,  sugar  and  salt,  pour  on  slowly  the  boiling 
water,  and  cook  in  double  boiler  fifteen  minutes.  Pour  this 
onto  the  apples,  which  have  been  pared  and  cored  and  the 
holes  filled  with  sugar  and  a  little  nutmeg.  Cover  the  dish 
and  bake  one-half  hour.    Serve  with  cream  and  sugar. 

RASPBERRY  TAPIOCA,  218  CALORIES 

(Three  Servings.) 
iVg  tablespoons  Minute  tapioca,    l^  cup  raspberry  juice. 
11/2  tablespoons  sugar.  Juice  %  lemon. 

1  cup  boiling  water.  Speck  salt. 

Mix  tapioca,  sugar  and  salt,  pour  on  slowly  the  boiling 
water  and  cook  in  double  boiler  fifteen  minutes.  Add  rasp- 
berry and  lemon  juice.  When  it  begins  to  jelly,  beat  smooth 
with  a  spoon.    Serve  plain  or  with  whipped  cream. 

DATE  TAPIOCA,  660  CALORIES 

(Three  Servings.) 
11/2  tablespoons  Minute  tapioca.    1  cup  scalded  milk. 
1  tablespoon  sugar.  1  egg. 

1/2  saltspoon  salt.  ^  cup  chopped  dates. 

Mix  tapioca,  sugar  and  salt;  add  gradually  the  hot  milk 
and  cook  in  double  boiler  fifteen  minutes.  Add  the  beaten 
egg  yolk  and  cook  three  minutes  longer.  Stir  in  the  dates. 
Make  a  meringue  of  the  white  of  egg,  heap  it  on  top  and 
brown  delicately  in  the  oven. 


CHOCOLATE  OR  COCOA  BLANC  MANGE,  827  CALORIES  1 

(Three  Servings.) 


l^  teaspoon  salt. 

Mix  tapioca,  sugar  and  salt;  pour  on  gradually  the  hot 
cocoa  and  cook  in  double  boiler  about  twenty  minutes.  Ee- 
move  from  heat,  add  vanilla  and  pour  into  cold,  wet  molds. 
Serve  cold,  plain  or  with  whipped  cream  or  Soft  Custard. 

^  Calculated  with  chocolate,  recipe  page  135. 


14  cup  Minute  tapioca. 
%  cup  sugar. 


iy2  cups  hot  chocolate  or  cocoa. 
14  teaspoon  vanilla. 


302 


NUTRITIOUS  DESSERTS 


BREAD  PUDDINGS 

The  principle  of  employing  farinaceous  matter  which  has 
already  been  subjected  to  heat  (so  that  a  considerable  con- 
version of  starch  has  gone  on  before  the  human  salivary 
diastase  comes  into  play)  is  carried  out  in  practice  in  the 
form  of  bread  puddings. 

PLAIN  BREAD  PUDDING,  900  CALORIES 

(Two  Servings.) 

2  tablespoons  sugar  (to  taste). 
14  saltspoon  salt. 
l^  cup  seeded  raisins. 

Scald  milk  and  add  butter.  Beat  the  egg  and  add  sugar 
and  salt;  pour  on  gradually  the  scalding  milk.  Cut  the 
bread  into  one-half  inch  cubes  and  add  with  the  raisins. 
Pour  into  well-buttered  pudding  dish,  put  bits  of  butter  on 
top  and  bake  in  a  moderate  oven  until  the  custard  is  set. 
Serve  with  Hard  Sauce  or  cream  and  sugar. 

Note. —  Do  not  serve  raisins  in  bowel  trouble. 

ORANGE  BREAD  PUDDING,  710  CALORIES  1 

(Two  Servings.) 

1  cup  stale  bread.  2  oranges. 

%  cup  milk.  Sugar  to  taste. 

2  eggs. 

Soak  bread  in  the  milk  until  soft  and  beat  lightly  with 
fork;  add  the  grated  rind  of  one  orange  and  the  juice  of 
both;  sweeten.  Beat  the  whites  very  light  and  add  to  above 
mixture.  Pour  into  custard  cups  and  cook  as  for  baked  cus- 
tard —  about  fifteen  or  twenty  minutes.  Serve  plain  or  with 
Hard  Sauce. 

Note. —  Omit  orange  rind  if  it  will  interfere  medicinally. 

^  Without  sugar. 


1  cup  stale  bread. 

1  cup  milk. 

1  tablespoon  butter. 


% 


BREAD  PUDDINGS 


303 


LEMON  BREAD  PUDDING,  543  CALORIES 

(Two  Servings.) 

cup  milk.  3  tablespoons  sugar. 

V2  cup  soft  bread  crumbs.  %  tablespoon  butter. 

Yolk  1  egg.  Grated  rind  %  lemon. 

Speck  salt. 

Scald  milk  and  add  butter.  Beat  the  egg  yolk^  add  sugar 
and  salt  and  pour  on  gradually  the  scalded  milk.  Add  the 
bread  crumbs  and  grated  lemon  rind;  pour  into  a  buttered 
pudding  dish  and  bake  in  a  moderate  oven  about  fifteen  min- 
utes^ or  until  set  like  baked  custard. 

Make  a  meringue  by  beating  the  white  of  egg  very  stiff, 
adding  two  tablespoons  powdered  sugar  and  juice  of  one- 
fourth  lemon.  Cover  the  pudding  with  it  and  set  in  the 
oven  till  a  dainty  brown. 

Xote. —  Do  not  use  lemon  rind  if  it  will  interfere  medici- 
nally. For  the  crumbs,  rub  soft  bread  through  a  coarse 
strainer. 

JELLY  BREAD  PUDDING 

Prepare  the  same  as  for  Lemon  Bread  Pudding,  omitting 
the  lemon  rind  and  juice.  Spread  any  tart  jelly  over  pudding 
when  baked  and  add  meringue. 

CHOCOLATE  BREAD  PUDDING,  904  CALORIES 

(Two  Servings.) 

y2  cup  stale  bread  crumbs.  2^4  tablespoons  sugar. 

1  cup  milk.  1  egg. 

%  ounce    (or    square)    Walter  Speck  salt. 

Baker's  unsweetened  chocolate,  l^  teaspoon  vanilla. 

Soak  bread  crumbs  in  milk.  Melt  chocolate  over  hot  water 
and  add  to  it  the  sugar  and  salt.  To  the  chocolate  mixture, 
add  the  soaked  crumbs^  the  beaten  egg  and  vanilla.  Put  into 
buttered  custard  cups  and  bake  in  a  moderate  oven  about 
twenty  minutes,  or  until  custard  is  set.  Serve  hot,  plain  or 
with  Hard  Sauce. 


304 


NUTRITIOUS  DESSERTS 


CHEESE  PUDDING  (FOR  THE  DIABETIC),  1400  CALORIES 

(Two  Servings.) 

2  eggs.  Speck  soda. 

1  cup  milk.  1  tablespoon  butter. 

%  cup  cheese.  Salt. 
1  cup  Gum  Gluten  bread  crumbs.  Cayenne. 

Dry  the  bread,  roll  and  soak  a  short  time  in  the  milk. 
Beat  the  eggs  lightly,  add  the  milk  and  crumbs,  grated  cheese^ 
salt  and  cayenne  pepper  to  taste.  Beat  well,  pour  into  but- 
tered pan  and  bake  in  a  hot  oven  half  an  hour.  Serve  im- 
mediately, as  five  minutes'  delay  will  spoil. 

GLUTEN  BROWN  BETTY  (FOR  THE  DIABETIC),  222  CALORIES  i 

3  Gum  Gluten  Biscuit  Crisps.  Sugar. 

1  large  sour  apple.  Cinnamon. 

2  teaspoons  butter. 

Into  a  well-buttered  individual  baking  dish  place  one 
crushed  Biscuit  Crisp;  onto  this  put  one-half  apple  cooked 
as  for  apple  sauce  or  raw  cut  in  thin  slices  or  chopped; 
season  with  sugar,  speck  of  cinnamon  and  bits  of  butter. 
Add  another  layer  of  crumbs  (one  Biscuit  Crisp),  then  the 
remaining  half  of  apple  and  seasoning,  lastly  crumbs.  Place 
bits  of  butter  on  top,  put  in  slow  oven,  and  bake. 

CRACKER  PUDDINGS 

CRACKER  PUDDING,  397  CALORIES 

(Two  Servings.) 
1%  soda  crackers.  Yolk  1  egg. 

1  cup  milk.  2  tablespoons  sugar. 

Ys  teaspoon  salt. 

Eoll  the  crackers  and  soak  in  the  milk.  Beat  yolks  and 
sugar  well  together  and  add  to  pudding  with  salt.  Bake 
one-half  hour.  Make  a  meringue  with  the  whites  of  the 
eggs,  pile  lightly  on  top  and  put  in  oven  till  golden  brown. 
Serve  hot. 


1  Without  sugar. 


PUDDING  SAUCES 


305 


ENGLISH  WALNUTS  AND   BISCUIT   CRISPS    (FOR  THE  DIA- 
BETIC), 154  CALORIES 

(Individual  Rule.) 
2  Gum  Gluten  Biscuit  Crisps.      4  walnut  halves. 

2  hot  tablespoons  thin  cream.  Parsley. 
l^  teaspoon  butter. 

Butter  Biscuit  Crisps  and  place  in  oven  until  well  heated 
through.  Dip  the  nuts  in  melted  butter  and  cook^  turning 
often  until  heated.  Cover  each  Crisp  with  one  tablespoon  of 
hot  cream  and  serve  two  nuts  on  each  Crisp;  garnish  with 
sprig  of  parsley. 

Note. —  Buttered  Biscuit  Crisps  may  be  served  heated  and 
served  with  ground  nut  meats  over  top. 

PUDDING  SAUCES 

HARD  SAUCE,  650  CALORIES 

(Four  Servings.) 

3  tablespoons  butter.  %  white  of  egg. 

6  tablespoons  powdered  sugar.      %  tablespoon  cream. 
Nutmeg. 

Cream  butter;  add  sugar  gradually.  When  light  and 
creamy  add  the  unbeaten  white  of  egg  and  the  cream^  a  drop 
or  two  at  a  time.  Season  highly.  Heap  on  serving  dish  and 
cool. 

FOAMY  SAUCE,  863  CALORIES 

(Three  Servings.) 
14  cup  butter.  %  egg. 

1/2  cup  powdered  sugar.  1  tablespoon  wine. 

Cream  butter;  add  sugar  gradually^  the  well-beaten  egg 
and  the  wine.  Heat  over  hot  water^  beating  constantly. 
Serve  immediately. 

TO  WHIP  CREAM 

14  cup  thick  cream  (40%)  =432  Calories. 
Do  not  have  cream  too  thick;  season  with  sugar  and  any 
flavoring  desired;  put  in  bowl  and  set  bowl  in  another  utensil 
containing  a  little  cold  water  and  ice.    Beat  cream  with  Dover 


306 


NUTRITIOUS  DESSERTS 


egg-beater  until  stiff  enough  to  keep  its  form.  Set  on  ice  to 
keep  cold. 

Note. —  Do  not  beat  too  long  or  it  may  turn  to  butter.  To 
one-half  cup  thick  cream  add  three  tablespoons  milk. 

WHIPPED  CREAM  NO.  II. 

1  egg  white  =  10  to  15  Calories. 
Follow  the  above  recipe,  and  add  the  white  of  one  egg 
beaten  stiff,  folding  it  into  the  stiffly-beaten  cream. 

FRUIT  SAUCE,  75  CALORIES 

(Two  Servings.) 

6  tablespoons  fruit  juice.  %  teaspoon  arrowroot  or  corn- 

starch. 

Blend  starch  with  a  little  cold  water  and  pour  into  the 
hot  fruit  juice.  Boil  two  or  three  minutes.  Sweeten  if  de- 
sired. 

ORANGE  SAUCE 

See  chapter  "  Gelatin    for  recipe.    Page  210. 

FROZEN  DESSERT 

ICE  CREAM  —  SHERBET  —  ICES 

Frozen  dishes  not  only  constitute  an  acceptable  form  of 
serving  nutriment^  but  often  are  a  means  of  furnishing  addi- 
tional liquid  and  relieving  thirst.  Ices  and  sherbets  made 
with  fruits  and  water^  have  a  dietetic  value  similar  to  acid 
beverages.  Frozen  cream,  milk^  junkets,  custards,  etc.,  have 
the  same  nutritive  value  as  the  same  foods  served  without 
freezing. 

In  giving  all  very  cold  dishes,  care  must  be  taken  not  to 
interfere  with  the  digestion  of  other  foods.  Chilling  the 
mouth  hinders  the  formation  and  activity  of  saliva;  chilling 
the  stomach  retards  gastric  digestion.  The  latter  effect  can 
be  avoided  by  eating  ice-cold  food  very  slowly,  so  that  it  is 
partially  warmed  before  reaching  the  stomach.  Frozen  foods 
should  not  be  given  when  ptyalin  digestion  is  especially  im- 
portant. 


ICE  CREAM 


307 


General  Rules  for  Freezing,  Ice  (or  snow)  and  salt  are 
required  for  the  process  of  freezing.  The  salt  melts  the  ice^ 
and  in  melting  absorbs  heat  from  the  mixture,  thus  causing  it 
to  freeze.  The  finer  the  ice,  the  more  quickly  the  freezing 
will  be  accomplished.  In  packing  a  freezer  allow  three  level 
measures,  of  ice  to  one  of  salt.  This  proportion  is  found  best 
for  fine-grained  mixture.  The  can  should  not  be  filled  more 
than  three-fourths  full,  as  the  liquid  expands  in  freezing,  and 
if  over-crowded,  the  cream  will  become  coarse-grained  and  the 
cover  may  be  pushed  up  allowing  the  salt  water  to  get  in. 

Freezing  in  Small  Amounts,  Put  mixture  to  be  frozen 
into  a  water-tight  baking  powder  can,  or  a  small  tin  pail  wdth 
cover,  and  stand  in  large  pail  or  bowl.  Pack  the  ice  and  salt 
alternately  under,  and  around  it  (ice  pounded  fine),  using 
one  part  salt  to  three  parts  ice.  Eemove  cover,  and  beat 
mixture  with  Dover  egg-beater  until  foamy,  replace  cover  and 
turn  can,  or  pail,  back  and  forth;  remove  cover  occasionally 
and  scrape  the  frozen  mixture  from  side  of  can,  and  beat 
thoroughly  with  fork.  The  mixture  will  freeze  in  twenty 
minutes.  When  frozen,  place  a  narrow  strip  of  cloth,  dipped 
in  melted  beef  fat  or  lard,  around  the  outside  of  cover  to  keep 
out  the  salt  water.  Eepack  in  ice,  or  ice  and  salt,  and  cover 
wtII  until  wanted. 

Serve  frozen  dishes  in  sherbet,  champagne,  or  high  glasses ; 
pass  on  small  plate  covered  with  doily,  and  at  the  side  of  the 
plate  a  small  cake,  wafer  or  a  few  orange  straws  may  be 
added ;  a  rose  will  add  to  the  attractiveness. 

ICE  CREAM 

VANILLA  ICE  CREAM,  310  CALORIES  i 

(Individual  Rule.) 
l^   cup  thin  cream  or   l^   cup       %  teaspoon  vanilla. 

heavy  cream  and  14  cup  milk.       Speck  salt. 
1^2  tablespoons  sugar. 

Blend  all  the  ingredients;  when  sugar  is  dissolved,  freeze 
in  a  small  pail  according  to  general  directions. 

^  Calculated  with  thin  cream. 


308 


NUTRITIOUS  DESSERTS 


CHOCOLATE  ICE  CREAM,  353  CALOKIES^i 

(Individual  Rule.) 
14  cup  thin  cream  or  l^  cup   ll^  tablespoons  sugar. 

heavy  cream  and  %  cup  milk.   1  tablespoon  boiling  water. 
14  square  Walter  Baker's  choco-   ^  teaspoon  vanilla. 

late.  Speck  salt. 

Melt  the  chocolate  over  hot  water,  add  the  boiling  water, 
sugar  and  hot  cream.  Cool,  add  vanilla  and  salt  and  freeze 
in  small  pail  according  to  general  directions. 

COFFEE  ICE  CREAM,  352  CALORIES  1 

(Individual  Rule.) 
%  cup  thin  cream  or        cup  ll^  tablespoons  sugar. 

heavy  cream  and       cup  milk.   Speck  salt. 
1  tablespoon  ground  coffee.  l^  cup  milk. 

Mix  coffee  and  milk,  put  into  double  boiler  and  cook  five 
minutes.  Strain  through  cheese-cloth  and  strainer;  add 
sugar,  salt  and  cream.  Cool  and  freeze  in  small  pail,  accord- 
ing to  general  directions. 

JUNKET  ICE  CREAM,  690  CALORIES  1 

(Two  Servings.) 
%  cup  cream.  Vs  Hansen's  Junket  Tablet. 

%  cup  milk.  2  teaspoons  cold  water. 

2^2  tablespoons  sugar.  %  teaspoon  vanilla. 

Heat  the  milk  until  lukewarm,  add  the  sugar  and  vanilla ; 
when  sugar  is  dissolved  add  the  tablet  dissolved  in  the  cold 
water.  Allow  it  to  stand  in  warm  room  until  firm,  then  beat 
thoroughly  and  turn  into  small  pail  and  freeze  according  to 
General  Eule. 

Note. —  A  variety  may  be  made  by  adding  two  teaspoons 
cocoa  dissolved  in  a  little  boiling  water.  Add  to  mixture 
before  adding  the  tablet.  Serve  the  creams  plain  or  with 
whole  strawberries,  etc. 

Note. —  The  junket  improves  the  body  or  consistency  of 
any  cream. 

^  Calculated  with  thin  cream. 


ICE  CREAM 


309 


GRAPE  JUICE  ICE  CREAM,  490  CALORIES 

(Individual  Rule.) 
%  cup  thin  cream.  %  cup  sugar. 

14  cup  Welch's  grape  juice. 

Scald  one-half  cup  of  the  cream  and  add  the  sugar.  Cool, 
add  remainder  of  cream  and  the  grape  juice  and  freeze  accord- 
ing to  general  directions. 

STRAWBERRY  ICE  CREAM,  356  CALORIES 

(Individual  Rule.) 
1/2   cup  thin  cream  or  l^   cup      2  tablespoons  sugar. 

heavy  cream  and  l^  cup  milk.       Speck  salt. 
14  cup  strawberries. 

Mash  the  strawberries  with  the  s.ugar  and  allow  them  to 
stand  five  minutes.  Add  the  cream  and  milk  and  freeze  in 
small  pail  according  to  general  directions. 

j^ote. —  The  berries  may  be  mashed  and  strained  through 
cheese-cloth. 

RASPBERRY  ICE  CREAM,  363  CALORIES 

(Individual  Rule.) 
14  cup  thin  cream  or   %   cup       2  tablespoons  sugar, 
heavy  cream  and  l^  cup  milk.       Speck  salt, 
cup  raspberries. 

Mash  the  raspberries  and  strain  through  cheese-cloth.  Add 
cream,  milk  and  sugar.  Freeze  in  small  pail  according  to 
general  directions. 

PEACH  ICE  CREAM,  390  CALORIES 

(Individual  Rule.) 
l^   cup  thin  cream  or   %   cup       l^  cup  peaches, 
heavy  cream  and  14  cup  milk.       2  tablespoons  sugar. 

Mix  peaches  and  sugar  and  press  through  a  potato-ricer 
or  sieve.  Scald  cream  and  milk.  Cool  and  add  peaches  and 
sugar.    Freeze  in  small  pail  according  to  general  directions. 


310 


NUTRITIOUS  DESSERTS 


CARAMEL  ICE  CREAM,  340  CALORIES 

(Individual  Rule.) 
l^   cup  thin  cream  or   14  cup   ll^  tablespoons  boiling  water. 

thick  cream  and  14  cup  milk.     1/3  teaspoon  vanilla. 
2  tablespoons  sugar.  Speck  salt. 

Into  saucepan  place  the  sugar  and  stir  constantly  until 
melted.  Add  water  and  boil  until  reduced  to  one  and  one- 
half  tablespoon.  Add  cream  very  slowly,  vanilla,  salt,  and 
freeze. 

CARAMEL  ICE  CREAM  NO.  II,  5942  CALORIES 

(Ten  Servings.) 
1  pint  milk.  2  eggs. 

1  cup  sugar.  Speck  salt. 

5  tablespoons  flour.  1  quart  cream. 

1  scant  cup  sugar  for  caramel. 

Scald  the  milk;  mix  one  cup  sugar,  flour  and  salt,  add  the 
eggs  and  beat  all  together  until  perfectly  smooth  and  light. 
Add  the  scalding  milk  gradually,  beating  until  very  smooth. 
Cook  in  double  boiler  twenty  minutes. 

While  cooking,  prepare  caramel.  Put  the  second  cup  of 
sugar  in  saute  pan,  and  cook  until  melted  and  a  delicate 
brown;  add  gradually  the  custard,  stirring  constantly;  strain 
and  cool.  Add  the  cream  (which  has  been  scalded  and 
cooled)  and  freeze  in  large  freezer. 

Note. —  This  may  be  used  for  vanilla  ice-cream  by  omit- 
ting the  caramel  and  using  one  tablespoon  vanilla  and  enough 
of  the  second  cup  of  sugar  to  sweeten. 

MALTED  MILK  ICE  CREAM,  3900  CALORIES  1 

(Ten  Servings.) 

1/2  pound  Horlick's  Malted  Milk.   1  pint  cream. 
1  cup  granulated  sugar.  2  ounces  chocolate. 

1  quart  water.  1  tablespoon  vanilla. 

White  1  egg. 

Mix  the  malted  milk  powder,  sugar  and  boiling  water,  stir- 
ring until  smooth.  Add  cream  and  scraped  chocolate  and 
cook  until  chocolate  is  melted.    Add  vanilla,  cool  and  freeze. 

1  Thick  cream. 


% 


ICE  CREAM 


311 


When  partly  frozen^  add  the  well-beaten  white  of  egg^  and 
finish  freezing. 

N'ote. —  If  strawberry  or  other  flavor  is  desired^  it  may  be 
used  in  place  of  vanilla. 

PEPTONOIDS  ICE  CREAM,  1274  CALORIES 

4    tablespoons    Dry    Peptonoids  %  pint  thin  cream. 

Soluble.  1  oz.  chocolate. 

V2  cup  sugar.  l^  tablespoon  of  vanilla. 

1  pint  of  water.  White  of  1  egg. 

Mix  Dry  Peptonoids  Soluble,  sugar  and  boiling  water. 
Stir  until  smooth.  Add  cream  and  scraped  chocolate.  Cook 
until  chocolate  is  melted.  Add  vanilla;  cool  and  freeze. 
When  partially  frozen,  add  well-beaten  white  of  egg. 

FROZEN  CUSTARD,  349  CALORIES 

(Two  Servings.) 
1  cup  hot  milk.  2  tablespoons  sugar. 

1  egg.  •  l^  teaspoon  vanilla. 

Speck  salt. 

Beat  the  egg,  add  the  sugar  and  salt  and  gradually  the 
scalded  milk.    Cool,  add  flavoring  and  freeze. 

HOT  COCOA  SAUCE  FOR  ICE  CREAM,  1035  CALORIES 

(Six  Servings.) 

cups  water.  2  tablespoons  Walter  Baker's  co- 

1  cup  sugar.  coa. 
1  tablespoon  arrowroot.  1  teaspoon  vanilla. 

Speck  salt. 

Boil  together  the  water  and  sugar  for  two  minutes;  add 
the  arrowroot  mixed  with  a  little  cold  water,  stir  for  a  mo- 
ment, then  boil  until  clear.  Add  the  cocoa,  which  has  been 
mixed  with  a  little  hot  water,  and  the  salt,  and  boil  three 
minutes  longer.    Remove  from  the  fire  and  add  the  vanilla. 


313 


NUTRITIOUS  DESSERTS 


SHERBET 

LEMON  MILK  SHERBET,  299  CALORIES 

(Individual  Rule.) 
l^  cup  milk.  Juice  of  %  lemon. 

14  cup  sugar.  1  drop  lemon  extract. 

Blend  all  the  ingredients  and  freeze  in  small  pail  accord- 
ing to  general  directions. 

LEMON  MILK  SHERBET,  NO.  II,  2390  CALORIES 

(Six  Servings.) 
1  quart  milk.  Juice  2  lemons. 

1  pint  sugar.  1  teaspoon  lemon  extract. 

To  the  lemon  juice  add  the  sugar,  milk  and  extract. 
Freeze  immediately  in  large  freezer. 

STRAWBERRY  SHERBET,  357  CALORIES 

(Individual  Rule.) 
cup  milk.  l^  cup  sugar. 

1  cup  strawberries. 

Mash  the  berries  and  strain.  To  the  juice  add  sugar  and 
milk.    Freeze  in  small  pail  according  to  general  directions. 

STRAWBERRY  SHERBET  NO.  II,  2940  CALORIES 

(Six  Servings.) 

1  quart  milk.  2  cups  sugar. 

2  quarts  strawberries. 

Mash  the  berries  and  strain.  Add  sugar  and  milk.  Freeze 
in  large  freezer. 

CLAM  SHERBET,  128  CALORIES 

(Individual  Rule.) 
%  cup  milk.  Speck  paprika. 

l^  cup  clam  broth. 

Blend  and  freeze  according  to  General  Eule.  Serve  in 
small  dainty  glasses  with  a  teaspoon  of  unsweetened  whipped 
cream  on  top.  The  milk  and  clam  taken  in  this  way  are 
often  more  acceptable  to  the  patient  than  when  served  in 
liquid  form. 


SHERBET 


313 


Note. —  The  paprika  may  be  omitted  if  condiments  are  not 
desirable. 

MALTED  mix  SHEEBET,  2148  CALOEIES 

(Six  Servings.) 
%  pound  Horlick's  Malted  Milk.   1  tablespoon  vanilla. 
1  cup  granulated  sugar.  2  ounces  chocolate. 

3  pints  water.  White  1  egg. 

Make  a  smooth  paste  of  the  malted  milk  powder  and  a 
little  of  the  water^  then  add  the  rest  of  the  water  gradually, 
the  sugar^  vanilla  and  the  chocolate  grated.  Freeze.  When 
partly  frozen,  add  the  well-beaten  white  of  egg  and  finish 
freezing. 

GRAPE  SHERBET,  3265  CALORIES 

(Ten  Servings.) 
3  cups  Welch's  grape  juice.  3  cups  sugar. 

1  quart  water.  White  2  eggs. 

Blend  the  grape  juice,  water  and  sugar.  Partly  freeze. 
Beat  the  whites  of  eggs  lightly,  add  two  tablespoons  pow- 
dered sugar ;  add  to  sherbet  and  continue  freezing  until  hard. 
Eemove  dasher  and  allow  it  to  stand  for  one  hour  to  ripen. 
Pack  carefully. 

GRAPE  AMBROSIA,  5243  CALORIES 

(Twelve  Servings.) 

1  quart  milk.  1  pint  Welch's  grape  juice. 

2  quarts  water.  1  can  grated  pineapple. 

cups  sugar.  Juice  3  lemons. 

Whites  4  eggs. 

Mix  together  milk,  water,  sugar  and  fruit  and  partially 
freeze.  Add  the  well-beaten  whites  of  eggs  and  continue 
freezing  until  hard. 

ICES 

ORANGE  ICE,  252  CALORIES 

(Individual  Rule.) 
%  cup  water.  1  tablespoon  lemon  juice. 

Juice        oranges.  l^  cup  sugar. 


314 


NUTRITIOUS  DESSERTS 


Mix  together  all  the  ingredients  and  freeze  in  small  pail 
according  to  general  directions. 

ORANGE  ICE  NO.  II,  990  CALORIES 

(Four  Servings.) 
2  tablespoons  shredded  gelatin.     1  cup  sugar. 
1/2  cup  cold  water.  1  cup  orange  juice. 

1%  cups  boiling  water.  Juice  1  lemon. 

Soak  gelatin  in  the  cold  water  twenty  minutes;  add  boil- 
ing water;  when  gelatin  is  dissolved  add  the  sugar,  orange 
and  lemon  juice.    Cool,  strain  and  freeze  in  large  freezer. 

ORANGE  ICE  NO.  Ill,  1922  CALORIES 

(Four  Servings.) 
1  pint  orange  juice.  Grated  rind  1  orange. 

Juice  2  lemons.  1  quart  water. 

1  pint  sugar. 

Boil  the  water  and  sugar  twenty  minutes;  add  fruit  juice 
and  rind  of  orange.    Cool,  strain  and  freeze  in  large  freezer. 

Note. —  Do  not  use  orange  rind  if  it  will  interfere  me- 
dicinally. 

LEMON  ICE,  257  CALORIES 

(Individual  Eule.)  . 
%  cup  water.  4  tablespoons  sugar. 

Juice  1  lemon. 

Mix  all  the  ingredients  and  freeze  in  small  pail  according 
to  general  directions. 

ERUIT  ICE,  497  CALORIES 

(Individual  Rule.) 
34  banana.  Juice  %  lemon. 

1/3  cup  strawberries.  %  cup  cold  water. 

Juice  y2  orange.  1/2  cup  sugar. 

Put  the  fruit  into  a  coarse  strainer  (or  a  potato-ricer),  rub- 
bing it  through  into  a  large  bowl.  Pour  the  cold  water 
through  the  strainer.  Add  the  sugar,  stir  well  and  freeze 
according  to  general  directions. 


ICES 


315 


PINEAPPLE  ICE,  242  CALORIES 

(Individual  Rule.) 
1^  cup  grated  pineapple.  %  cup  \y^ter. 

1  tablespoon  lemon  juice.  2  tablespoons  sugar. 

Boil  the  water-  and  sugar  together  about  three  minutes ; 
add  pineapple  and  lemon  juice.  Cool^  strain  and  freeze  ac- 
cording to  general  directions. 

GRAPE  FRAPPE,  2175  CALORIES 

(Six  Servings.) 
1  pint  Welch's  grape  juice.  1  pint  water. 

Juice  1  lemon.  2  cups  sugar. 

Boil  the  water  and  sugar  together  for  five  minutes;  cool 
and  add  the  grape  and  lemon  juice.  Freeze  to  the  con- 
sistency of  a  mush.  Serve  in  tall  glasses  with  sweetened 
whipped  cream  piled  high  on  top. 

CLAM  ERAPPE 

(Individual  Rule.) 
%  cup  cold  water.  Speck  paprika. 

1/4  cup  clam  broth. 

Blend  and  freeze  according  to  General  Eule,  to  the  con- 
sistency of  a  soft  Water  Ice.  Serve  in  small  punch-glasses 
or  champagne  glasses,  with  a  teaspoon  of  unsweetened 
whipped  cream  on  top  —  Delicious  to  serve  for  dinner  in 
place  of  shellfish. 

SCALPICON  OF  FRUIT 

A  delicious  scalpicon  is  made  by  cutting  all  kinds  of  fresh 
fruits  into  small  pieces  flavoring  with  wine  or  lemon  juice 
and  sugar.  Put  into  serving  dish  with  Orange  or  Lemon 
Ice  on  top.  Serve  individually  in  champagne  glasses  on  a 
small  plate  with  doily,  with  a  single  rose  or  other  flower  to 
correspond  with  color  of  ice. 

ORANGE  STRAWS 

Peel  the  orange  or  lemon  lengthwise ;  cut  into  long,  narrow 
strips,  about  one-fourth  of  an  inch  wide.    Put  into  saucepan 


316 


NUTRITIOUS  DESSERTS 


and  cover  with  cold  water  and  bring  to  the  boiling  point  and 
pour  off  the  water;  repeat  this  process  five  or  six  times^  or 
until  the  bitter  taste  of  peel  is  extracted.  Drain  thoroughly 
and  cover  with  granulated  sugar.  Cook  until  sugar  is  dis- 
solved and  is  thick  and  hardens  in  cold  water.  Then  roll 
straws  in  granulated  sugar  and  cool.  Serve  with  Orange  Ice, 
etc.,  or  as  a  bon-bon. 


CHAPTEE  XII 


CAKE 

The  two  methods  of  making  cake  light  are  by  means  of 
air  and  of  gas.  Air  is  introduced  by  beating,  or  by  the 
addition  of  beaten  eggs,  as  in  sponge  cake.  When  the  light- 
ness is  entirely  dependent  upon  air,  the  whites  and  yolks  of 
eggs  should  be  beaten  separately. 

Gas  may  be  generated  from  within  by  combining  an  acid 
and  alkali  and  adding  moisture;  as  cream  of  tartar  and 
bicarbonate  of  soda ;  or  sour  milk  and  soda ;  or  molasses  and 
baking  powder.  The  combination  of  both  air  and  gas  is 
used  to  raise  butter  cakes. 

General  Directions  for  Cake  Making.  Before  blending  the 
cake,  see  that  the  oven  is  at  right  temperature  for  baking 
and  the  pans  greased  with  a  little  beef  fat  and  dredged  with 
flour.  The  pan  may  be  lined  with  paper  to  prevent  cake 
burning  on  bottom  when  cake  requires  long  baking  or  when 
the  oven  bakes  too  quickly  on  the  bottom.  Have  all  material 
at  hand  and  measured.  Use  a  round  bottom  bowl,  and  a 
wooden  spoon  for  mixing;  beat  rather  than  stir  the  mixture 
and  fold  in  ingredients.  Put  mixture  in  cake  pans,  slightly 
higher  on  the  sides  than  in  the  center,  as  cake  rises  more 
quickly  in  the  center.  Layer  cake  takes  a  hotter  oven  than 
loaf  cake.  If  cake  is  baked  properly,  it  will  rise,  but  not 
brown,  during  first  quarter  of  the  time  required  for  baking; 
become  slightly  browned  the  second  quarter;  well  browned 
during  the  third;  and  shrink  from  the  pan  during  the 
fourth. 

If  the  oven  is  too  hot,  a  crust  will  form  over  the  top  be- 
fore the  cake  has  risen  sufficiently  and  the  cake  will  break 

317 


318 


CAKE 


open  on  the  top.  If  the  oven  is  too  cool  the  cake  will  rise  too 
much  and  will  be  of  coarse  texture. 

Place  pans  in  oven  in  such  position  that  they  may  remain 
and  do  not  move  them  before  the  third  quarter  of  the  baking. 
If  the  top  of  the  cake  should  brown  too  quickly  cover  with 
a  piece  of  light  weight  paper^  slightly  buttered  on  the  one 
side  and  next  to  the  cake. 

Cake  is  sufficiently  baked  when  it  shrinks  slightly  from 
the  edge  of  the  pan  and  feels  firm  to  the  touch ;  if  when 
tested  with  a  fine  washed,  and  heated  knitting  or  darning 
needle  and  it  comes  out  clear.  In  looking  at  cake  do  not 
open  the  oven  door  too  wide  and  only  for  a  moment,  and 
care  must  be  taken  not  to  jar  the  door  in  closing. 

SPONGE  CAKE,  1390  CALORIES 

4  eggs.  lYo  teaspoons  Rumford's  baking 

.1  cup  powdered  sugar.  powder. 
%  cup  bread  flour.  Rind  and  juice  of  %  lemon. 

%  teaspoon  salt. 

Beat  eggs  separately^  very  light.  To  the  yolks  add  the 
sugar  and  lemon^  sift  in  carefully  the  flour  blended  with  the 
baking  powder  and  beat  about  five  minutes.  Then  fold  in 
the  whites.  Bake  in  a  well-greased  and  floured "  angel  cake 
tin  in  a  moderate  oven.  Cake  is  done  if  when  tested  with  a 
fine  (washed)  knitting  needle  it  comes  out  clear,  or  when  the 
cake  shrinks  from  the  pan.  \ 

COLD  WATER  SPONGE  CAKE,  1633  CALORIES 

2  eggs.  2    teaspoons    Rumford  baking 

1  cup  sugar.  powder. 

6  tablespoons  cold  water.  1  tablespoon  lemon  juice. 

11/3  cups  bread  flour. 

Beat  the  yolks  and  whites  separately.  To  the  yolks  add 
the  sugar  and  beat  well ;  add  lemon  juice  and  cold  water ;  sift 
flour  and  baking  powder  together  three  times  and  add  grad- 
ually, beating  thoroughly. 

Fold  in  the  well-beaten  whites.  Bake  in  well-greased  and 
floured  gem  tins,  or  shallow  pan  in  a  moderate  oven. 


CAKE 


319 


HOT  WATER  SPONGE  CAKE,  1460  CALORIES 

2  eggs.  Yz  saltspoon  salt. 

1  cup  sugar.  teaspoon  vanilla. 

1  cup  bread  flour.  %  cup  boiling  water. 
ll^  teaspoons  Rumford  baking 

powder. 

Beat  the  eggs  very  light,  add  the  sugar;  sift  dry  ingredients 
together  and  add  gradually;  add  flavoring  and  beat  well. 
Lastly  add  the  boiling  water,  and  bake  in  well-greased  and 
floured  gem  tins,  or  shallow  pan,  in  a  moderate  oven. 

PLAIN  CAKE,  2230  CALORIES 

2  eggs.  4  tablespoons  butter. 

%  cup  milk.  2    teaspoons    Rumford  baking 

1  cup  sugar.  powder. 

1%  cups  bread  flour  blended  with  1  teaspoon  flavoring  or  spices. 
2  tablespoons  corn-starch. 

Line  the  pan  with  buttered  paper;  separate  eggs.  Cream 
the  butter,  add  the  sugar  gradually,  add  the  well-beaten  yolks 
and  flavoring.  Add  alternately  the  milk  and  the  flour  with 
the  baking  powder  sifted  in  it.  Beat  well  and  fold  in  the 
stiSly-beaten  whites.  Put  at  once  in  a  well-lined  and  greased 
pan,  and  bake  in  a  hot  oven  about  thirty  minutes,  or  until  it 
shrinks  from  the  pan^  or  until  a  fine  (washed)  knitting  needle 
comes  out  dry. 

The  cake  may  be  varied  by  adding  one-fourth  cup  currants, 
or  a  few  raisins  and  a  little  citron,  or  mixed  spices,  or  a  little 
melted  chocolate.  Before  adding  fruit  to  cake  it  should  be 
slightly  floured. 

GLUTEN  NUT  CAKE  (FOR  THE  DIABETIC),  1436  CALORIES  1 

1  tablespoon  butter.  l^  teaspoon  Sweetina. 

Yolks  2  eggs.  Salt  and  spices. 

Whites  2  eggs.  1  cup  nut  meats. 

2/3  cup  sour  milk.  Gum  Gluten  Flour. 

1  teaspoon  soda. 

Cream  the  butter,  add  the  well-beaten  yolks  and  Sweetina 
syrup,  then  the  sour  milk  in  which  the  soda  has  been  blended. 
Add  Gum  Gluten  Flour  gradually  to  make  a  stiff  batter; 

1  Without  gluten  flour. 


320 


CAKE 


season  with  salt  and  spices  and  add  nut  meats.  Bake  in 
moderate  oven. 

BOILED  FROSTING,  853  CALORIES 

1  cup  sugar.  White  1  egg. 

l^  teaspoon  cream  of  tartar.        14  teaspoon  flavoring. 

%  cup  cold  water. 

Boil  the  sugar,  cream  of  tartar  and  cold  water  without  stir- 
ring until  it  threads  from  spoon,  and  gradually  pour  on  to 
the  well-beaten  white  of  egg.  Add  any  flavoring  to  taste. 
Beat  until  thick  and  spread  quickly.  A  little  chocolate  may 
be  added  for  variety,  or  chopped  nuts  or  cocoanut,  etc. 

MARGTJERITE  WAFERS 

Take  "  Long  Branch  wafer  crackers  and  spread  with 
plain-boiled  frosting,  or  add  nuts,  chocolate,  cocoanut,  etc. 
Put  in  oven  a  moment  to  dry,  but  not  brown.  Dainty  to 
serve  with  Ice  Cream,  Ices  and  Sherbet. 

GINGER  BREAD,  2600  CALORIES 

1  egg.  %  cup  boiling  water. 

1  cup  molasses.  1  teaspoon  ginger. 

7  tablespoons  melted  butter.  1%  cups  bread  flour  or 

1  teaspoon  soda.  2%  cups  pastry  flour. 

Beat  egg  in  mixing  bowl ;  add  molasses,  melted  butter,  and 
gradually  one  cup  of  flour.  To  the  remaining  flour  add  the 
soda  and  ginger,  sift  and  add  to  mixture;  beat  well  and  add 
the  boiling  water.  Bake  in  well-greased  and  floured  gem  tins, 
or  shallow  pan,  in  a  hot  oven  about  twenty  minutes.  Test 
with  a  fine  (washed)  darning  needle;  when  it  comes  out  clear, 
or  the  cake  shrinks  from  the  pan  the  cake  is  done. 


PART  III 
HOSPITAL  DIETAEIES 
DIET  m  DISEASE 
DIET  m  SPECIAL  CONDITIONS 


CHAPTER  XIII 


HOSPITAL  DIETARIES 
GENEEAL  TYPES  OF  DIET  USED  IN  HOSPITALS 

LIQUID  OR  FLUID  FOODS 

Acid^  starchy  and  miscellaneous  drinks.  Eaw  eggs  in  the 
form  of  all  albuminous  drinks.  Milk  in  different  ways  as 
given  in  recipes  under  chapter;  thus  milk  may  be  flavored 
with  cocoa,  chocolate,  coffee  or  meat  broth ;  diluted  with  lime 
water,  ApoUinaris  or  Vichy ;  combined  with  starchy  drinks  or 
strained  gruels.  Broths  of  various  kinds;  beef  juice;  beef 
tea ;  beef  extract.  Soups,  both  clear  and  creamy ;  oysters  and 
clams. 

SOFT  OR  SEMI-SOLID  FOOD 

Milk  and  water  gruels.  Water,  milk  or  creamy  toast. 
Starchy  and  meat  jellies.  Custards  in  various  forms.  Whips 
and  souffles.  Junkets,  cornstarch  puddings  or  blanc-mange, 
gelatins.  Ice  cream,  sherbet,  ices.  Plain  cream,  butter,  olive 
oil,  mayonnaise  dressing,  cod  liver  oil,  plain  or  emulsified. 

SOLID  FOODS 

Gruels  and  mushes.  Various  forms  of  bread,  toast  and 
crackers.  Eggs  prepared  in  many  forms.  Meats  cooked  in 
various  ways;  as  beef,  mutton,  lamb;  chicken,  turkey  or 
game;  sweetbreads;  fish,  oysters,  clams.  Suitable  vegetables 
and  fruits. 

TYPICAL  DIETS  FROM  VARIOUS  HOSPITALS 

LIGHT  DIET  i 
(or  Convalescent  Diet) 

Breakfast. —  Milk,  tea,  coffee  or  cocoa  (with  milk  and  sugar). 
Bread  and  butter,  white  bread,  graham  bread  or  toast. 
Cereals  with  cream.  Eggs  (any  style  except  fried).  Fruit: 
fresh  in  season  or  dried. 

1  Diet  used  at  Nathan  Littauer  Hospital,  Gloversville,  New  York. 

323 


324 


HOSPITAL  DIETARIES 


Dinner. —  Tea  (milk).  Soup,  with  stock  or  broths;  or  cream  soup. 
Crackers,  bread  and  butter.  Eggs:  soft  boiled  or  poached  or 
raw  (if  desired).  Vegetables:  baked  or  stuffed  potato  or  rice. 
Desserts:  light  puddings  or  ices  or  ice  cream  or  jellies  or 
custards  or  fresh  or  stewed  fruits  or  baked  apples. 

Supper. —  Tea  (milk).  Fruit:  (fresh  in  season),  dried,  canned  or 
preserved.  Bread  and  butter:  white  bread,  toast,  milk  toast; 
egg  or  fruit  sandwich.  Vegetables:  baked  or  stuffed  potato, 
creamed  baked  potato;  rice,  baked  bananas  or  macaroni 
< plain).  Eggs  (any  style  except  fried).  Light  puddings  or 
custards,  jellies,  plain  cakes. 

TYPICAL  LIGHT  DIET  i 

Breakfast. —  Oranges,  coffee  with  milk  and  sugar,  or  tea;  milk,  cream 

of  wheat,  eggs  (soft  cooked  in  shell),  toast. 
Dinner. —  Tea  and  milk,  soup,  crackers,  bread  and  butter,  baked 

potato,  snow  pudding. 
Supper. —  Tea,  milk,  bread  and  butter,  steamed  rice,  canned  peaches, 

cake,  jelly. 

MILK  DIET  2 

During  the  day  give  6  to  8  ounces  every  two  hours. 
During  the  night  give  6  to  8  ounces  every  three  hours. 
(When  very  ill  give  every  two  hours  during  the  night.) 

FLUID  DIETS 

Milk,  beef  tea,  chicken  broth,  mutton  broth,  egg  albumin. 

SOFT  DIET  3 

Cereals,  soft  eggs,  milk  toast,  custard,  farinaceous  puddings,  tea, 
coffee,  cocoa,  milk. 

SOFT  SOLIDS  4 

Soft  toast,  soft  eggs,  crackers  in  milk  or  broth,  jellies  of  all  kinds, 
ice  cream,  soft  puddings  without  raisins,  liquids  of  all  kinds,  soups 
strained,  very  weak  tea,  coffee  or  cocoa. 

Avoid:  meat,  potatoes,  vegetables. 

LiaUID  OR  FARINACEOUS  4 

Cereals,  bread,  jellies,  liquids,  ice  cream,  custard,  blanc-mange, 
puddings  (without  raisins),  chicken. 

1  Diet  used  at  Nathan  Littauer  Hospital,  Gloversville,  New  York. 

2  Diet  used  at  Bellevue  Hospital,  New  York. 

3  Diet  used  at  the  Presbyterian  Hospital,  New  York. 

■*  Diet  used  at  the  Massachusetts  General  Hospital,  Boston. 


TYPICAL  HOSPITAL  DIETS 


325 


FARINACEOUS  DIET  i 

Breakfast, —  Tea  or  coffee  (milk  and  sugar).  Bread  and  butter: 
white  bread  or  graham  bread  or  rolls  or  muffins  or  toast. 
Cereals. 

Dinner. —  Soup :  vegetable  or  macaroni  or  barley  broth.  Bread  or 
crackers.  Vegetables:  baked  potatoes  or  tomatoes  or  French 
beans  or  rice  or  macaroni  or  samp.  Puddings:  rice  or  bread 
or  cracker  or  tapioca  or  farina  or  cornstarch  or  arrowroot. 

Supper. —  Tea  (milk  and  sugar).  Bread  and  milk  or  milk  toast  or 
hominy  or  boiled  rice  or  puffed  rice  with  custards  or  milk  or 
farina  or  banana  or  potatoes  baked.  Fruit:  apples  (stewed 
or  baked)  or  prunes  or  pears  or  peaches  or  apricots  (other 
fruits). 

NITROGENOUS  DIET  2 

Meat,  fish,  eggs  (not  fried),  oysters,  junket,  custard,  ice  cream, 
string  beans,  soup  and  oatmeal;  with  crackers,  fruit,  butter  and  let- 
tuce. 

Breakfast. —  Milk  or  tea  or  coffee  (with  milk).  Bread  and  butter: 
graham  bread.  Meats:  eggs  or  fresh  fish  or  stew  without 
vegetables  or  meat  or  hash  without  potatoes. 

Dinner. —  Soup :  stock  or  chowder,  graham  bread.  Meats :  beef 
(roast  or  boiled)  or  fresh  fish  or  Irish  stew.  Vegetables: 
spinach,  lettuce,  celery  or  string  beans.    Desserts:  custards. 

Supper. —  Tea  (milk),  graham  bread  and  butter  or  bread  and  milk, 
eggs  or  cold  meat. 

NUTRIENT  DIETS 

Two  eggs  strained  through  muslin  into  a  tablespoon  of  cold 
water  until  dissolved.  Add  this  to  four  to  six  ounces  of  cold 
milk,  add  one-half  drachm  salt,  dissolved  in  water.  If  pa- 
tient is  very  low  add  tincture  opii  (deodorized).  At  times 
beef  juice,  one-half  drachm  is  added,  but  is  not  necessary. 

OXALURIA  DIET  2 

Oxaluria,  as  the  name  signifies,  is  an  excess  of  oxalate  of 
lime  in  the  form  of  crystals  in  the  urine,  usually  affecting  the 
nervous,  irritable  dyspeptic.    It  is  considered  that  possibly  the 

^  Diet  used  at  Nathan  Littauer  Hospital,  Gloversville,  New  York. 

2  Diet  used  at  the  Massachusetts  General  Hospital,  Boston, 

3  Elbridge  J.  Cutler,  M.D. :  Diet  used  at  the  Massachusetts  General  Hos- 
pital, Boston,  Mass. 


326 


HOSPITAL  DIETARIES 


frequency  of  the  disease  among  the  poorer  classes  is  due  to 
an  excessive  vegetable  diet,  sugar  and  starch  foods,  com- 
bined with  irritating  activities.  The  diet  should  be  carefully 
regulated,  though  liberal.  All  vegetables  and  drugs  contain- 
ing oxalates  must  be  avoided;  all  lime  or  hard  water  should 
be  forbidden  and  replaced  by  boiled  or  distilled  water.  Sugar 
should  be  prohibited,  coffee  and  tea  replaced  by  milk. 

Avoid  asparagus,  celery,  cauliflower,  green  beans,  tomatoes, 
spinach,  rhubarb,  potatoes,  sorrel,  carrots,  parsnips,  berries, 
apples,  pears,  plums,  grapes,  chocolate  and  cocoa.  Cut  carbo- 
hydrates low.  Give  this:  (1)  eggs,  toast,  milk;  (2)  meat  or 
fish,  green  vegetables,  except  those  forbidden;  peas,  onions, 
custard,  fruit,  ice  cream;  (3)  cereals,  cold  meat,  cooked  fruit, 
except  forbidden  forms. 

STRICT  SUGAR-FREE  DIET 
Massachusetts  General  Hospital  i 

See    Diabetic  Diet.''    Page  357. 

SPECIAL  FAT-FREE  DIET  i 

Breakfast. —  Lean  meat,  100  gms. ;  toasted  bread,  50  gms. ;  coffee  with 
a  little  milk  and  saccharine  (no  butter,  no  cream,  no  sugar). 
11  A.  M.,  albumin  water  of  2  eggs. 

'Moon. —  Clear  soup,  fat-free;  bread,  50  gms.;  lean  meat,  100  gms. 
4  P.  M.,  albumin  water  of  2  eggs. 

Supper. —  Lean  meat,  100  gms.;  bread,  50  gms.;  rice,  50  gms. 

SALT-FREE  DIET  i 

See  Nephritis  Diet.    Page  393. 

TEST  DIETS  1 

Much  stress  is  laid  upon  test-diets  in  order  to  determine  the 
ability  of  the  patient  to  properly  assimilate  fats,  proteins  or 
carbohydrates.  These  test-diets  are  known  as  "  fat-free  days/^ 
"  sugar-free  days/'  "  vegetable  days/'  "  oatmeal  days/'  and  a 
diet  giving  the  proper  amount  of  bulk,  containing  little  pro- 
teids  and  carbohydrates,  with  the  caloric  value  of  the  fat  so 
low  that  it  is  styled  "  starvation  days.'' 

^  Diet  used  at  the  Massachusetts  General  Hospital,  Boston. 


TYPICAL  HOSPITAL  DIETS  337 


The  main  test-diet  is  the  Schmidt  diet  as  modified  by  Dr. 
Hewes.^  It  runs  three  days^  beginning  with  breakfast,  and 
is  as  follows : 

Schmidt  Diet 

Morning. —  Fifty  grammes  zwieback;  l^  litre  oatmeal  gruel,  made 
of  40  gms.  rolled  oats,  200  c.c.  milk,  300  c.c.  water,  1  egg,  10 
gms.  butter.    11a.  m.,  l^  litre  milk. 

'Noon, —  125  gms.  chopped  beef  broiled  and  made  palatable  with  20 
gms.  butter;  250  gms.  potato  mashed  with  10  gms.  butter;  50 
gms.  toast.    4  P.  M.,  one-half  litre  mild. 

'Night, —  Same  as  morning.  (Stools  third  and  fourth  days.)  It  is 
carefully  weighed,  measured,  and  prepared,  and  one-fifth  ad- 
ditional of  the  amount  served  is  sent  to  the  laboratory  for 
analysis.  All  the  patient  does  not  consume  is  weighed  and 
deducted;  all  urine  and  feces  are  calculated. 

HOSPITAL  EXTRA  DIET  2 

Chicken,  ^ggs,  stale  bread  and  toast,  scraped  beef,  sand- 
wiches, blanc-mange,  soft  custard  without  raisins;  raw  oys- 
ters, milk,  broths,  gruels,  soups,  milk  whey,  oranges,  lemonade, 
crackers,  jelly,  ice  cream,  weak  tea,  coffee  or  cocoa. 

FISH  DIET 

Consists  of  a  ration  of  bread,  ten  ounces,  and  fish,  eight 
ounces  (the  uncooked  measure),  such  as  haddock,  cod  or  sole, 
or  similar  fish,  potatoes,  eight  ounces,  cocoa,  one  ounce,  with 
half  an  ounce  of  sugar  and  a  sixth  of  a  pint  of  milk. 

This  is  a  serviceable  form  of  diet  for  those  for  whom  large 
quantities  of  meat  are  not  only  unnecessary  but  injurious. 

BROTH  DIET 

In  children's  hospitals  a  diet  is  sometimes  classified  as  the 
"broth  diet,''  consisting  of  mutton  broth  flavored  with  veg- 
etables, and  bread  and  butter,  with  milk ;  or  a  "  beef  tea  diet," 
in  which  beef  tea  replaces  the  broth.  In  the  lighter  diet  of 
children,  gruels,  bread  and  molasses,  and  simple  farinaceous 

^  Dr.  Hewes,  Physician  to  Out-Patients,  Massachusetts  General  Hospital. 
^  Diet  used  at  the  Massachusetts  General  Hospital,  Boston. 


328 


HOSPITAL  DIETARIES 


foods  such  as  farina,  cornstarch,  rice,  etc.,  should  play  an 
important  role.  Sometimes  such  a  diet  goes  under  the  name 
of  "  soft  food.'' 

RESTRICTED  DIET 

Breakfast. —  Tea  or  coffee  (with  milk  and  sugar).    Farinaceous  food 

(with  milk).  Eggs. 
Dinner. —  Soup ;  raw  oysters,  roast  beef,  steak  or  chicken  and  veg- 
etables.   Pudding  (bread,  rice,  tapioca  or  cornstarch). 
Supper, —  Tea  (with  milk  and  sugar ) .    Bread  ( with  butter ) .  Fruit 

(fresh  or  dried) . 

BELLEVTJE  HOSPITAL  IN  THE  CITY  OF  JHEW  YORK,  1910 
Dietary  Table  for  Patients 

MONDAY 

Breakfast. —  Coflfee,  with  milk  and  sugar,  bread  and  butter,  oatmeal, 

crackers,  milk  (1  qt. ) . 
Dinner. —  Roast  beef,  rice,  soup,  potatoes,  vegetables,  bread. 
Supper. —  Tea   (with  milk  and  sugar),  bread  and  butter,  stewed 

apples. 

TUESDAY 

Breakfast. —  Coffee  (with  milk  and  sugar),  bread  and  butter,  hominy, 

crackers,  milk  (1  qt. ) . 
Dinner, —  Mutton  stew,  potatoes,  vegetables,  bread,  bread  pudding. 
Supper. —  Tea  (with  milk  and  sugar),  bread  and  butter,  prunes. 

WEDNESDAY 

Breakfast. —  Coffee  ( w^th  milk  and  sugar ) ,  bread  and  butter,  rice, 

crackers,  milk  (1  qt. ) . 
Dinner. —  Roast  beef,  barley  soup,  potatoes,  bread. 
Supper. —  Tea   (with  milk  and  sugar),  bread  and  butter,  stewed 

prunes. 

THURSDAY 

Breakfast. —  Coffee  (with  milk  and  sugar),  bread  and  butter,  oatmeal 

crackers,  milk  (1  qt.). 
Dinner. —  Beef  stew,  potatoes,  vegetables,  bread. 

Supper. —  Tea   ( with  milk  and  sugar ) ,  bread  and  butter,  stewed 
apricots. 

FRIDAY 

Breakfast. —  Coffee  ( with  milk  and  sugar ) ,  bread  and  butter,  two 

eggs,  crackers,  milk  (1  qt. ) . 
Dinner. —  Baked  fish,  potatoes,  vegetables,  bread,  rice  pudding. 
Supper. —  Tea  (with  milk  and  sugar),  bread  and  butter,  prunes. 


TYPICAL  HOSPITAL  DIETS  329 


SATURDAY 

Breakfast. —  Coffee  (with  milk  and  sugar),  bread  and  butter,  hominy, 

crackers,  milk  (1  qt. ) . 
Dinner. —  Mutton  stew,  potatoes,  vegetables,  bread. 
Supper. —  Tea   (with  milk  and  sugar),  bread  and  butter,  stewed 

prunes,  apples. 

SUNDAY 

Breakfast. —  Coffee  (with  milk  and  sugar),  bread  and  butter,  crack- 
ers, milk  (1  qt.),  two  eggs. 
Dinner. —  Corn  beef,  bean  soup,  potatoes,  bread,  cornstarch  pudding. 
Supper. —  Tea  (with  milk  and  sugar),  bread  and  butter,  prunes. 

MILK  DIET 

To  be  prescribed  by  the  attending  physician  or  surgeons. 

ARTICLES  OF  SPECIAL  DIET 
Beefsteak,  beef  tea,  chicken,  chicken  soup,  rice  and  milk,  eggs, 
milk. 

DIETARY  OF  THE  PRESBYTERIAN  HOSPITAL  IN  THE  CITY  OF 
NEW  YORK,  1910 

HOUSE  DIET 

Breakfast. —  Tea  or  coffee  (milk  and  sugar).  Bread  and  butter: 
White  bread  or  Graham  bread  or  corn  bread  or  rolls  or  toast. 
Porridge:  Oatmeal  or  wheaten-grits  or  Indian  meal  or  hom- 
iny or  farina  or  samp.  Meats:  Hash  or  eggs  or  salt  fish 
or  fresh  fish  or  stew. 

Dinner. —  Soup :  Stock  or  mutton  broth  with  barley  or  vegetable  or 
chowder;  dry  bread.  Meats:  Beef  (roast  or  boiled)  or  mut- 
ton (roast  or  boiled)  or  corned  beef  or  fresh  fish  or  Irish 
stew.  Vegetables:  Potatoes,  baked,  boiled  or  mashed  and 
tomatoes  or  baked  beans  or  French  beans  or  turnips  or 
beets  or  rice  or  macaroni  or  samp.  Pudding:  Rice  or  bread 
or  tapioca  or  farina  or  cornstarch  or  custard. 

Supper. —  Tea  (sugar  and  milk),  bread  and  butter  or  toast  and 
butter.    Fruit:  Apples  stewed  or  baked  or  prunes  or  pears. 

CONVALESCENT  DIET 
Breakfast. —  Tea  or  coffee   (milk  and  sugar).    Bread  and  butter. 
White  bread  or  Graham  bread  or  corn  bread  or  rolls  or  toast. 
Porridge:  Hominy  or  farina.    Meats:  Eggs  or  fresh  fish  or 
stew  (plain). 

Dinner. —  Soup :  Stock  or  chicken  or  mutton  broth  with  barley  or 
vegetable.    Dry  bread.    Meats:   Beef    (roast  or  boiled)  or 


330 


HOSPITAL  DIETARIES 


chicken  or  fish  (fresh).  Vegetables:  Potatoes  (baked)  or  rice 
or  macaroni  or  samp.  Pudding:  Rice  or  bread  or  tapioca  or 
farina  or  cornstarch  or  custard. 
Supper. —  Tea  (milk  and  sugar).  Bread  and  milk  or  milk  toast  or 
bread  and  butter  or  toast  and  butter.  Fruit:  Apples  stewed 
or  baked  or  prunes  or  pears. 

NITROGENOUS  DIET 
Breakfast. —  Tea  or  coffee  (milk),  bread  and  butter,  Graham  bread. 

Meats:  Eggs  or  fresh  fish  or  stew  without  vegetables  or  meat, 

hash  without  potatoes. 
Dinner. —  Soup :    Stock  or  chowder,  Graham  bread.    Meats :  Beef 

(roast  or  boiled)  or  mutton  (roast  or  boiled)  or  fresh  fish  or 

Irish   stew.    Vegetables:    Spinach   or   lettuce   or   celery  or 

string  beans.    Pudding:  Custard. 
Supper. —  Tea  (milk),  Graham  bread  and  butter  or  bread  and  milk, 

eggs  or  cold  meat. 

FARINACEOUS  DIET 
Breakfast. —  Tea  or  coffee   (milk  and  sugar).    Bread  and  butter: 

White  bread  or  Graham  bread  or  corn  bread  or  rolls  or  toast. 

Porridge:  Hominy  or  farina  or  Indian  meal. 
Dinner. —  Soup :  Vegetable  or  macaroni  or  barley  broth ;  dry  bread. 

Vegetables:   Baked  potatoes  and  tomatoes  or  French  beans 

or  rice  or  macaroni  or  samp.    Pudding:   Rice  or  bread  or 

tapioca  or  farina  or  cornstarch. 
Supper. —  Tea  (milk  and  sugar)  bread  and  milk  or  milk  toast  or 

hominy  or  boiled  rice  or  farina.    Fruit:  Apples  stewed  or 

baked  or  prunes  or  pears. 

MILK  DIET 
Breakfast. —  One  quart  of  milk. 
Dinner. —  One  quart  of  milk. 
Supper. —  One  quart  of  milk. 

EXTRAS 

ORDERED   ONLY   BY   THE   ATTENDING    PHYSICIAN   OR  SURGEON 

Mutton  chops,  beef  steak,  scraped  beef,  beef  tea  (made  with  hydro- 
chloric acid),  chicken  (broiled,  fricasseed  or  roast),  chicken 
broth,  eggs,  milk,  oysters,  clam  broth,  gruels,  crackers,  ginger 
bread,  custard,  milk  toast. 


CHAPTEK  XIV 


DIET  IN  DISEASE 

One  of  the  most  striking  differences  between  the  older  and 
more  recent  methods  of  treatment  of  disease  is  the  careful 
attention  bestowed  upon  the  diet  at  the  present  day.  For  it  is 
now  recognized  that  the  proper  selection  of  food,  both  solid 
and  fluid,  is  of  as  much  importance  as  the  use  of  medicaments. 
In  the  management  of  diseases  affecting  the  digestive  organs 
proper,  and  in  all  affections  of  metabolism  (gout,  obesity  and 
diabetes,  for  example)  the  diet  may  be  said  to  represent  the 
treatment,  and  there  is  hardly  any  disease  which  may  not  be 
benefited  by  intelligent  feeding. 

These  matters,  however,  are  left  entirely  to  the  medical  prac- 
titioner, and  it  is  only  exceptionally  that  the  nurse  is  required 
to  assume  any  responsibility.  She  should  know  in  a  general 
way,  however,  the  types  of  food  suitable  in  different  diseased 
conditions,  so  that  she  may  avoid  harmful  foods  when  not 
given  specific  instructions,  and  so  that  she  may  adapt  the 
prescribed  diet  to  the  tastes  of  the  individual.  For  this  pur- 
pose, an  outline  of  the  diets  in  use  in  common  diseases  is 
included  in  this  volume. 

DIET  IN  FEVERS  AND  INFECTIOTIS  DISEASES 

DIET  IN  FEVER  IN  GENERAL 

In  fevers  due  to  poisons  circulating  in  the  blood,  there  is 
an  interference  with  heat  regulation,  so  that  the  heat  gen- 
erated in  the  body  cannot  be  gotten  rid  of  in  the  normal 
way;  an  increased  metabolism;  and  a  disturbance  of  the  di- 
gestive and  absorptive  functions.  It  is,  therefore,  desirable  to 
give  easily  digested  food,  in  small  quantities  at  frequent  in- 

331 


332 


DIET  IN  DISEASE 


tervals,  preferably  in  liquid  form^  as  substances  dissolved  in 
water  are  more  readily  absorbed^  and  water  tends  to  aid  in 
cooling  the  body  to  normal  temperature. 

For  the  first  three  or  four  days,  patients  previously  strong, 
should  be  given  only  fluid  foods.  But  since  a  normal  man, 
lying  quietly  in  bed,  requires  about  2000  calories  to  com- 
pensate for  daily  loss  of  energy,  and  in  the  increased  metab- 
olism of  fever,  this  requirement  is  increased,  it  is  necessary 
that  more  substantial  food  be  incorporated  into  the  diet  as  far 
as  is  possible  without  disturbing  digestion. 

DIET. —  Milk  is  the  staple  food,  but  must  be  given  with  care, 
swallowed  very  slowly  and  diluted  with  limewater,  soda,  seltzer  or 
other  eflfervescent  water  —  one  part  to  two  parts  milk. 

If  milk  can  be  taken,  two  or  three  pints  should  be  given  —  four 
ounces  every  two  hours,  or  six  ounces  every  three  hours.  In  case 
milk  does  not  agree,  whey  may  be  given  as  a  substitute  for  milk  in 
part  or  in  whole.  Modified  milk  or  peptonized  milk  may  be  given. 
Sometimes  the  milk  may  be  flavored  with  tea,  coffee,  cocoa  or 
malted  milk  and  junket  used. 

Next  to  milk  the  most  important  article  of  diet  is  beef  juice  and 
broths.  Next  come  well  cooked  gruels.  Later  well  prepared  cereals 
and  malt  extract  are  valuable,  and  plain  or  cocoa  junkets.  Usually 
there  is  thirst,  and  all  acid  drinks,  such  as  grape  juice,  may  be  taken. 

Panopepton  with  crushed  ice,  peptonised  milk,  clam,  mutton  and 
chicken  broth,  beef  tea,  clear  soups,  thickened  with  some  farinaceous 
substance,  gelatin  jellies,  are  all  of  value. 

Liquids. —  Pure  cold  water,  toast  water,  any  of  the  acid  drinks, 
all  sipped  slowly,  are  recommended  both  to  relieve  thirst  and  on 
account  of  facilitating  the  speed  with  which  the  waste  matter  re- 
sulting from  increased  metabolism  of  the  fever  is  eliminated  through 
the  kidneys. 

AVOID. —  Any  solid  or  vegetable  food  or  fruits,  until  permitted 
by  the  physician  in  charge. 

DIET  IN  CONVALESCENCE  FROM  FEVER 
Thompson  i 

Convalescents  who  have  long  subsisted  solely  upon  fluids 
must  be  careful  in  resuming  solid  diet^  for  the  rapidity  of 
recuperation  of  the  digestive  organs  varies  in  different  per- 

iW.  Oilman  Thompson,  M.D. :  "Practical  Dietetics."  New  York.  D. 
Appleton  &  Co. 


FEY  EES  AND  INFECTIOUS  DISEASES  333 


sons,  and  taking  meats  or  other  solid  foods  too  soon  may  cause 
rise  in  temperature,  rapid  heart  action,  and  possibly  visceral 
congestion.  The  first  meat  given,  therefore^  should  be  in  a 
finely  subdivided  state,  such  as  scraped  beef  or  minced  chicken. 

During  convalescence  from  protracted  fevers  the  more 
easily  digested  forms  of  starchy  foods  are  found  to  be  very 
useful,  especially  if  there  has  been  much  loss  of  weight.  Sago 
and  tapioca,  and  dried  bread  crumbs  rolled  through  a  fine 
sieve  may  be  added  to  thicken  clear  meat  broths.  Crackers 
and  zwieback  are  useful. 

Other  ingredients  which  may  be  added  to  thicken  soups 
during  convalescence  are  panada,  semolina,  tapioca,  and  maca- 
roni. Custard  puddings,  cooked  fruit,  wine  and  beef  jellies, 
blanc-mange,  or  baked  custard,  may  be  allowed.  "  Mush,'^ 
fine  hominy,  cornstarch^  farina,  and  boiled  rice,  with  beef 
juice,  can  be  ordered. 

The  following  dietary  will  serve  as  a  general  guide  for 
feeding  convalescents  from  fevers  of  ordinary  severity  in 
which  special  lesions  of  the  alimentary  canal  are  not  present. 

FIRST  DAY 
Breakfast. —  Poached  egg  on  toast.  Cocoa. 
Lunch. —  Milk  punch. 

Dinner, —  Raw  oysters.    Cream  crackers.    Light  wine  if  desired. 
Lunch. —  One  cup  of  hot  meat  broth. 
Supper, —  Milk  toast.    Wine  jelly.  Tea. 

SECOND  DAY 

Breakfast. —  Soft  cooked  egg.    Milk  punch.    Coffee  with  sugar  and 
cream. 

Lunch. —  One  cup  of  soft  custard. 

Dinner. —  Cream  of  celery  soup.    Sippets  of  toast.    A  little  "barley 

pudding,  with  cream.    Sherry  wine  if  desired. 
Lunch. —  Milk  punch. 

Supper. —  Water  toast,  buttered.    Wine  jelly.  Tea. 

THIRD  DAY 
Breakfast. —  Coddled  eggs.    Cream  toast.  Cocoa. 
Lunch. —  One  cup  of  hot  chicken  broth. 

Dinner. —  Chicken  panada.    Bread.    Light  wine  if  desired.    A  little 
tapioca  cream. 


334 


DIET  IN  DISEASE 


Lunch. —  An  eggnog. 

Supper, —  Buttered  dry  toast.    Baked  sweet  apples  and  cream.  Tea. 
FOURTH  DAY 

Breakfast. —  An  orange.    Oatmeal  (H.  0.),  with  cream  and  sugar. 

Poached  egg  on  toast.    Baked  potato.  Cocoa. 
Lunch. —  One  cup  of  hot,  soft  custard. 

Dmner. —  Potato    soup.    Croutons.    A    small    piece    of  beefsteak. 

Creamed  potatoes.    Baked  custard.  Coffee. 
Lunch. —  One  cup  of  chicken  broth,  with  rice. 

Supper. —  Raw  oysters.  Banquet  crackers.  Graham  bread,  toasted 
Wine  jelly.  Tea. 

FIFTH  DAY 

Breakfast. —  An  orange.    Coffee.    Oatmeal,  with  cream  and  sugar. 

Broiled  mutton  chop.  Toast. 
Lunch. —  One  cup  of  mulled  wine. 

Dinner. —  Chicken  soup.  Bread.  Creamed  sweetbreads.  Duchess  po- 
tatoes.   Snow  pudding.  Cocoa. 

Lunch. —  Siphon  soda,  with  coffee  syrup  and  cream. 

Supper. —  Buttered  dry  toast.  Orange  jelly.  Sponge  cake  and 
cream.  Tea. 

A  further  discussion  of  this  topic  will  be  found  in  the  sec- 
tion upon  Convalescence  in  Typhoid  Fever. 

While  brandy  and  whiskey  constitute  the  best  form  in 
which  to  give  alcohol  in  the  acute  stage  of  fever^  in  con- 
valescence it  is  often  advisable  to  use  some  other  alcoholic 
drink,  and  an  occasional  change  from  one  variety  to  another 
renders  the  patient  somewhat  less  liable  to  the  danger  of 
acquiring  a  permanent  alcoholic  habit.  For  convalescence, 
if  the  patient's  purse  can  afford  it,  champagne,  port  wine, 
sherry,  Madeira,  or  a  good  claret  or  Burgundy,  may  be  taken 
with  advantage,  in  the  class  of  cases  above  mentioned. 

TYPHOID  FEVER 

The  modern  dietetics  of  typhoid  may  be  conveniently  con- 
sidered under  three  plans  of  feeding  as  follows : 

1.  Starvation  Treatment  of  Typhoid,  This  ancient  method 
of  feeding  or  omitting  to  feed  typhoid  patients  has  recently 
been  revived  with  alleged  good  results,  but  those  who  have 
tested  the  method  are  thus  far  few  in  number  and  it  is  veiy 


FEVERS  AND  INFECTIOUS  DISEASES  335 


unlikely  that  the  profession  as  a  whole  will  ever  adopt  it, 
especially  since  we  know  what  may  be  done  with  liberal  feed- 
ing. Typhoid  subjects  are  commonly  youngs  vigorous  and 
well  nourished  and  can  naturally  subsist  for  a  long  time  on 
their  own  stored-up  nutriment ;  while  by  starvation  they 
are  protected  from  intestinal  fermentation  of  undigested  food. 
Hence  such  patients  may  seem  to  do  well  for  a  number  of 
days  on  water  alone  given  in  unlimited  quantities.  But  this 
represents  but  one  aspect,  and  that  a  narrow  one,  in  the  prob- 
lem of  feeding  typhoid  patients,  and  is  applicable  only  to 
particular  cases  and  particular  stages  of  such  cases.  Much 
would  also  depend,  perhaps,  on  other  methods  of  treatment 
in  use.  Thus  if  the  fever  were  kept  down  by  cold  baths, 
the  demand  for  nutriment  would  doubtless  be  less  than  were 
the  fever  allowed  to  pursue  its  course. 

With  advancing  age  the  mortality  rate  increases  greatly,  and 
patients  above  thirty-five  or  forty  doubtless  require  nutri- 
ment to  a  greater  extent  than  the  youthful. 

2.  Liquid  Diet  in  Typhoid.  This  consists  chiefly  of  milk, 
varied  with  broths  and*  cereal  decoctions.  The  milk  which  is 
the  mainstay,  is  given  in  amounts  up  to  two  quarts  in  twenty- 
four  hours,  other  articles  being  given  only  now  and  then  to 
vary  the  monotony.  Milk  may  itself  be  administered  in 
various  forms  —  peptonised  milk,  whey,  malted  milk  and 
junket,  kumyss  and  artificially-soured  milk.*  Water  is  also 
given  freely.  This  mode  of  dieting  has  been  for  many  years 
the  prevailing  one  for  the  acutely  dangerous  period  of  the 
disease,  having  succeeded  the  earlier  beef  tea  diet.  Under 
liquid  diet  may  also  be  mentioned  the  various  predigested 
foods,  which,  by  reason  of  their  concentrated  state,  are  of 
value  when  there  is  difficulty  in  ingesting  enough  milk  to 
make  up  the  proper  fuel  value  for  the  day. 

Of  late  years,  it  has  been  claimed  that  milk  is  unsuited 
for  diet  in  typhoid  because  it  forms  an  ideal  culture  medium 
for  bacteria.  A  much  older  objection  is  the  necessary  forma- 
tion of  irritating  curds  from  the  cows'  milk  usually  given. 
This  last  objection  has  been  met  to  some  extent  by  peptonisa- 

*  Ewald  recommends  Sanatogen  in  milk  and  broth. 


336 


DIET  IN  DISEASE 


tion  of  the  milk^  and  by  ingesting  it  very  slowly,  so  that  no 
large  clot  can  quickly  form.  Milk  already  curdled  and  emul- 
sified, as  in  the  form  of  kumyss  and  other  fermented  products 
escapes  this  objection,  and  is  less  favorable  to  putrefaction. 
But  the  most  weighty  objection  to  a  fluid  diet  is  probably 
found  in  the  belief  that  it  gives  too  few  calories  in  propor- 
tion to  the  volume  of  food  injected,  and  hence  like  the 
starvation  treatment  is  not  adapted  for  routine  use  but  only 
for  special  cases  and  special  periods. 

3.  Liberal  or  Generous  Diet,  This  in  its  widest  sense  is 
doubtless  the  only  sound  routine  plan,  for  it  permits  the  use 
of  semi-solid  food  if  the  patient  can  take  it  and  digest  it. 
It  allows  considerable  variety,  for  such  dishes  as  custard,  ice 
cream,  arrowroot,  calf's  foot  jelly  and  the  like,  usually  re- 
served for  convalescence,  may  often  be  taken  safely  at  an 
early  period  in  the  disease.  There  is,  in  fact,  hardly  any 
line  drawn  as  to  how  far  a  person  may  go,  provided  he  does 
not  go  beyond  the  dietary  proper  for  delicate  stomachs. 
Baked  potato,  baked  apple,  rice  pudding,  w^ater  toast  and 
similar  articles  are  gradually  added  to  'the  diet  and  even  lamb 
chop  and  soft-boiled  eggs  are  given  while  the  temperature  is 
still  elevated.  This,  of  course,  is  in  direct  violation  of  the 
older  rule  of  giving  liquid  food  until  fever  has  completely 
subsided.  The  justification  appears  to  lie  in  the  fact  that 
liberal  diet  often  saves  life,  and  in  cases  where  the  chances 
seem  against  recovery  it  is  one  of  the  reserve  cards  to  play. 
Because  if  the  patient  is  likely  to  die  in  any  case,  the  solid 
diet,  if  it  can  be  tolerated,  cannot  add  to  the  risk  and  may 
be .  of  incalculable  value.  This  observation  was  made  long 
ago  in  connection  with  such  diseases  as  childbed  fever,  blood 
poisoning,  erysipelas,  meningitis,  gangrene  and  similar  mala- 
dies with  a  natural  tendency  to  go  from  bad  to  worse;  and 
the  severest  types  of  typhoid  belong  in  the  same  category  of 
diseases. 

Note. — "  High  Caloric  Feeding  in  typhoid  which  has  been 
tested  in  recent  years  is  known  as  the  high  caloric,  in  which 
it  is  aimed  to  give  the  patient  far  more  calories  than  he 


FEVERS  AND  INFECTIOUS  DISEASES  337 


should  utilize  in  healthy  even  at  the  hardest  labor  and  on  the 
most  liberal  diet.  This  is  the  exact  antithesis  of  the  water 
or  starvation  diet^,  in  which  the  patient  subsists  on  his  own 
tissues.  In  the  high  caloric  plan  the  theory  is  to  supply 
such  an  excess  of  nutriment  that  the  least  possible  loss  of  tis- 
sue occurs;  so  that  the  period  of  convalescence  and  recupera- 
tion should  be  greatly  shortened.  Certain  physicians  have 
actually  claimed  a  gain  in  weight  during  the  fever  under 
plans  of  this  character.  It  is  obviously  very  difficult  to  feed 
typhoid  patients  with  food  having  the  highest  calorific  value. 
Even  the  blandest  fats  are  badly  tolerated^,  as  is  also  cane 
;sugar.  It  is  possible,  however,  to  use  glucose,  dextrin,  and 
especially  lactose,  along  with  brandy,  more  or  less  in  connec- 
tion with  ordinary  feeding,  to  such  a  degree  that  in  in- 
dividual cases  the  number  of  calories  in  the  ordinary  liberal 
diet  may  be  practically  doubled. 

Whatever  shortcomings  exist  in  connection  with  caloric 
feeding  are  naturally  increased  with  the  amount  of  food. 
There  is  practically  no  limit  to  what  can  be  ingested  in 
twenty-four  hours,  but  there  may  be  a  limit  to  utilization. 
The  amount  of  calories  actually  used  can  only  be  determined 
by  painstaking  investigation  of  the  excreta.  There  is  also 
great  individual  variation  in  the  oxidation  of  special  food- 
stuffs, as  is  seen  notably  in  alcohol.  The  greater  the  daily 
intake,  the  greater  the  difficulty  in  establishing  common 
standards.  For  this  and  other  reasons  it  is  best  to  regard 
caloric  feeding  as  merely  a  check  on  the  older  methods  and 
on  common  experience.  It  is  hardly  likely,  therefore,  that 
high  caloric  feeding  will  ever  come  into  vogue,  although  it 
may  have  a  field  in  the  individual  case  or  at  some  special 
period  in  a  case. 

LIQTJID  DIET  IN  TYPHOID  FEVER 

In  the  ordinary  case,  two  and  a  half  pints  of  milk  and  a 
pint  and  a  half  of  beef,  mutton  or  chicken  broth  will  be  a  fair 
average  supply,  given  in  divided  quantities,  alternately. 
Give  ten  ounces  at  a  time,  every  three  hours;  the  broths  will 


338 


DIET  IN  DISEASE 


come  in  after  every  second  supply  of  milk.  The  amount  of 
meat  broths  must  be  governed  by  the  state  of  the  bowels.  If 
diarrhoea,  then  broths  must  not  be  given,  or  should  be 
given  in  very  small  quantities. 

Broths  tend  to  increase  diarrhoea.  In  some  cases  meat  jelly 
iced  or  extract  of  meat  may  be  taken  in  place  of  broths,  a 
teaspoon  being  given  at  a  time. 

The  chief  guide  in  the  matter  of  food  in  typhoid  must  be 
found  in  the  condition  of  the  stools.  The  physician  in  charge 
of  the  case  should  himself  see  the  feces  daily.  If  any  signs 
of  undigested  food  appear,  there  is  something  regarding  the 
dietary  that  is  wrong.  If  masses  of  hard  curd  appear  in  the 
motion,  there  is  probably  too  much  milk  given  in  the  twenty- 
four  hours,  or  it  is  being  given  in  too  large  quantities  at  a 
time. 

It  may  be  that  the  quantities  are  not  wrong,  and  that  dilu- 
tion of  the  milk,  or  the  addition  of  an  alkali,  or  of  some 
farinaceous  material  in  powder  well  cooked  in  milk  will  an- 
swer the  purpose  by  preventing  the  formation  of  the  firm 
curd. 

Milk^  if  not  retained  or  digested,  should  be  peptonised. 

The  chill  may  be  taken  from  milk  by  adding  a  little  hot 
water,  and  twenty  drops  of  the  saccharated  solution  of  lime 
in  each  supply  will  secure  alkalinity.  Farinaceous  substances 
to  use  in  milk  are  arrowroot  and  baked  flour,  to  aid  in  subdi- 
vision of  the  curd.  Food  should  not  be  given  as  the  nurse 
sees  fit,  but  definite  directions  should  be  laid  down  as  to  the 
quantity  to  be  given  at  a  time  and  the  mode  of  its  administra- 
tion. 

Indication  for  the  use  of  alcohol  lies  in  the  condition  of 
the  heart.  A  small,  frequent,  easily  compressed  pulse,  espe- 
cially if  associated  with  feebleness  of  the  first  sound  of  the 
heart,  is  a  clear  indication  that  alcohol  is  required.  The 
amount  given  should  be  small  —  from  a  teaspoon  to  a  table- 
spoon, or  one  ounce  of  wine. 

Alcohol,  on  account  of  effect  only  lasting  for  a  short  time, 
should  be  given  every  two  hours,  so  that  stimulation  is  kept 


FEVERS  AND  INFECTIOUS  DISEASES  339 


up.  In  giving  alcohol,  you  get  an  effect  first  of  stimulation, 
then  depression. 

The  use  of  alcohol  is  not  advocated  by  some  physicians. 

TYPHOID  FLUID  DIET  OF  PRESBYTERIAN  HOSPITAL  i 

Milk,  broth,  egg  albumin. 

TYPHOID  FLUID  DIET  OF  GLOVERSVILLE  HOSPITAL  ? 

Milk,  strained  broths  of  chicken,  mutton,  beef,  clam  broth, 
barley  water,  farina,  arrowroot  and  other  gruels,  custards,  egg- 
nog,  weak  tea,  bouillon,  junket,  cream,  egg  albumin,  gelatin. 

DIET  IN  CONVALESCENCE  FROM  TYPHOID 
Thompson  s 

As  the  fever  subsides,  it  becomes  an  important  question 
how  soon  to  allow  a  return  to  solid  food.  Eelapses  are  very 
easily  induced  by  indiscretion  in  this  regard. 

The  patient's  appetite  is  always  a  dangerous  guide  to  fol- 
low in  this  disease.  After  four  or  five  weeks  of  an  exclusive 
milk  or  milk  and  broth  diet,  when  the  temperature  subsides, 
and  often  before  it  has  become  normal,  he  becomes  ravenous. 
Like  a  long-starved  man,  he  thinks  of  nothing  but  food,  and 
demands  something  new  to  eat  every  day.  A  hospital  ward 
containing  a  dozen  convalescing  typhoid  fever  patients,  is 
difficult  to  manage,  as  a  bread  riot  is  constantly  menaced.  Ill- 
advised  but  sympathetic  friends  attempt  to  smuggle  in  all 
manner  of  forbidden  fruits,  and  the  patient  just  arrived  at 
the  hungry-  state  is  tempted  to  steal  solid  food  from  his  more 
advanced  neighbors. 

In  the  milder  cases  it  is  undoubtedly  both  safe  and  wise 
to  allow  a  strengthening  diet  at  an  early  date,  and  it  will 
greatly  prolong  convalescence  to  forbid  it.  Light  farinaceous 
diet  —  tapioca,  rice,  vermicelli,  cream-toast,  a  cracker  soaked 
in  cream,  etc. —  may  be  given  with  impunity  in  cases  which 
have  run  a  mild  course,  as  soon  as  the  temperature  remains 

1  Diet  used  at  the  Presbyterian  Hospital,   New  York. 

2  Diet  used  at  the  Nathan  Littauer  Hospital,  Gloversville,  N.  Y, 

3  W,  Oilman  Thompson,  M.D.:  "Practical  Dietetics."  New  York.  D. 
Appleton  &  Co. 


340 


DIET  IN  DISEASE 


normal.  Meat  broth  may  be  thickened  with  rice,  sago,  or 
vermicelli.  In  a  day  or  two  more,  the  soft  part  of  oysters 
or  a  chop  are  permissible  in  cases  which  have  presented  no 
need  of  prolonging  a  fluid  diet  for  fear  of  intestinal  injury. 

The  following  is  a  list  of  fluids  suitable  for  the  different 
days  of  convalescence^  commencing  a  day  or  two  after  disap- 
pearance of  all  fever.  Milk  should  still  be  given,  until  grad- 
ually wholly  replaced  by  solid  food : 

DIET  IN  TYPHOID  AFTER  TWO  DAYS  OF  NORMAL  TEMPERA- 
TURE i 

First  Day. —  Chicken  broth  thickened  with  thoroughly  boiled  rice. 
Milk  toast  or  cream  toast  once  only  during  the  day.  Beef 
juice. 

Second  Day. —  Junket,  mutton  broth,  and  bread  crumbs.  Cocoa. 
Milk  toast.  A  piece  of  tender  steak  may  be  chewed  but  not 
swallowed.  One  of  the  prepared  farinaceous  foods,  such  as 
Horlick's,  may  be  given  with  a  cup  of  hot  milk. 

Third  Day. —  A  small  scraped  beef  sandwich  at  noon.  A  soft  cooked 
egg  or  baked  custard  for  supper.  Boiled  rice  or  potato  puree 
strained.    Arrowroot  gruel. 

Fourth  Day. —  The  soft  part  of  three  or  four  oysters.  Meat  broth 
thickened  with  a  beaten  egg.  Cream  toast.  Rice  pudding  or 
blanc-mange  and  whipped  cream,  or  Bavarian  cream. 

Fifth  Day. —  Scraped  beef  sandwich.  A  tender  sweetbread.  Bread 
and  milk.  A  poached  egg.  Wine  jelly  or  calf's  foot  jelly. 
Macaroni. 

Sixth  Day. —  Mush  or  crackers  and  milk,  scrambled  eggs,  chicken 

jelly.    Bread  and  butter.    The  soft  parts  of  raw  oysters. 
Seventh  Day. —  A  small  piece  of  tenderloin  steak  or  a  little  breast  of 

broiled  chicken.    Bread  and  butter.    Boiled  rice.    Wine  jelly. 

Sponge  cake  and  whipped  cream. 
Eighth  Day. —  A  slice  of  tender  rare  roast  beef,  a  thoroughly  baked 

mealy  potato   served  with  butter  or  mashed   with  cream. 

Other  food  as  before. 
Ninth  Day. —  A  little  broiled  fresh  fish  for  breakfast.    Beef  steak  at 

dinner.    Bice,  macaroni,  eggs.    Sago,  rice,  or  milk  pudding. 

A  baked  apple. 

Tenth  Day. —  Mush  and  milk.  A  squab  or  breast  of  partridge  or 
roast  chicken.    Other  foods  as  before.    Ice  cream. 

W.  Gilraan  Thompson,  M.D. :  "Practical  Dietetics."  New  York.  D. 
^ppleton  &  Co. 


FEVERS  AND  INFECTIOUS  DISEASES  341 


For  the  next  four  or  five  days  the  patient  may  select 
articles  from  the  menu  of  the  previous  day,  so  that  three 
good  meals  a  day  are  taken,  besides  three  or  four  glasses  of 
milk  between  meals. 

It  is  often  desirable  to  give  a  little  alcoholic  stimulant, 
especially  if  there  is  much  difference  in  the  frequency  of  the 
pulse  between  lying  and  sitting  or  standing,  or  if  the  pulse 
rate  is  very  low,  say  56,  as  it  sometimes  is.  A  glass  of  sherry 
or  a  good,  sound  Burgundy,  or  a  tumbler  of  ale  may  be 
drunk,  but  with  meals  only. 

DIET  IN  TYPHOID  AFTER  TWO  WEEKS  OF  NORMAL  TEMPERA- 
TURE 

Presbyterian  Hospital  i 

Strained  vegetable  soups,  baked  apples,  baked  potatoes,  oat- 
meal. 

TYPHOID  DELICACIES 
Presbyterian  Hospital  i 

Eice  (well  cooked),  junket,  custard,  gruels,  milk  toast, 
scraped  beef,  eggs. 

TYPHOID  EXTRA  DIET 
Presbyterian  Hospital  i 

Broths,  beef  soups,  oysters,  white  fish,  beef,  chops,  mutton, 
steak,  custard,  eggs,  chicken,  rice,  white  bread,  toast,  farina- 
ceous puddings. 

Avoid  vegetables,  fruit,  pastry  or  hot  bread. 

LIBERAL  DIET  IN  TYPHOID  FEVER 

Shattuck  2 

When  typhoid  fever  kills  it  does  so  either  by  perforation 
or  exhaustion,  the  proportion  of  the  former  being  estimated 
at  5  to  10  per  cent.  The  main  factors  in  producing  the  ex- 
haustion which  causes  the- death  of  at  least  nine-tenths  of  the 
fatal  cases  are  toxemia,  continued  fever,  diarrhoea  and  vomit- 

^  Diet  used  at  the  Presbyterian  Hospital,  New  York. 

2  Frederick  C.  Shattuck,  M.D. —  Read  by  title  in  the  Section  on  Practice 
of  Medicine  at  the  Forty-eighth  Annual  Meeting  of  the  American  Medical 
Association  at  Philadelphia,  Pa.,  June  1-4,  1897. 


342 


DIET  IN  DISEASE 


ing,  and  intestinal  hemorrhage.  The  heart  is  ordinarily  the 
best  index  of  the  presence  and  degree  of  exhaustion^  and  the 
most  frequent  serious  pulmonary  complication^  hypostasis,  in 
its  various  forms,  degrees  and  consequences,  is  the  direct  out- 
growth of  the  cardiac  weakness.  Moreover,  typhoid  fever  is 
not  short  and  sharp  like  pneumonia,  but  of  long  course,  and 
usually  attended  with  decided,  often  with  very  great  wasting 
of  the  muscular  and  fatty  tissues. 

Most  of  us  are  agreed  that  we  are  not  as  yet  acquainted 
with  any  therapeutic  measures  which  will  either  abort  or  very 
materially  shorten  the  course  of  the  disease.  We  are,  I  think, 
unanimous  in  believing  that  husbanding  the  strength  from 
the  start  through  skillful  nursing,  the  judicious  use  of  water 
externally  and  internally,  and  the  supervision  of  a  wise  at- 
tendant on  the  watch  for  and  prepared  to  meet  such  indica- 
tions as  may  arise,  materially  modifies  the  course  of  the  dis- 
ease and  lessens  its  mortality.  If  w^hat  I  have  assumed  to  be 
facts  be  really  facts,  the  question  of  diet  must  be  a  very 
important  one  in  the  management  of  typhoid  fever.  It  is 
through  the  food  which  is  assimilated,  not  through  that  which 
is  merely  put  into  the  stomach,  that  we  seek  to  limit  the  tis- 
sue waste  while  the  process  is  active,  and  also  try  to  land  the 
patient  on  the  low  shore  of  convalescence  with  as  much  of  his 
property  as  may  be;  for  the  recovery  of  his  property  is  a 
necessary  preliminary  to  the  attainment  of  the  high  tableland 
of  full  health. 

Under  the  old  doctrines  as  to  inflammation^  fever  was  an 
unfailing  indication  for  depletion;  directly  by  venesection, 
pukes,  sweats  and  purges;  indirectly  by  starvation.  Indis- 
criminate direct  depletion  is  now  a  thing  of  the  past,  and 
since  the  time  of  Todd  the  fact  has  gradually  been  more  and 
more  clearly  recognized  that  the  febrile  state  is  often  an 
indication  for  more,  rather  than  less,  nourishment,  w^ith  selec- 
tion as  to  quality,  rather  than  diminution  as  to  quantity.  In 
the  shorter  essential  fevers  a  few  days^  starvation  cannot  do 
much  harm,  and  may  even  be  of  great  service  with  a  certain 
class  of  patients.    But  suppurative  fever  for  instance,  whether 


FEVERS  AND  INFECTIOUS  DISEASES  343 


of  tubercular  or  other  origin^  especially  if  chronic,  we  feed 
to  the  largest  limit ;  and  we  do  this  because  we  treat  the  con- 
dition and  not  the  disease,  individualizing  our  cases.  Since 
our  knowledge  of  gastric  chemistry  has  been  enriched  by  the 
adaptation  of  the  soft  catheter  to  another  hollow  viscus  at  the 
opposite  extremity  of  the  abdomen,  a  more  complete  explana- 
tion has  been  afforded  for  the  fact  which  we  knew  by  practical 
experience  before,  that  gastric  digestion  is  often  weakened  in 
the  febrile  state.  But  the  same  practical  experience  teaches 
us  that  it  is  not  always  so,  or  very  materially  so,  and  when 
theory  and  practice  conflict,  the  former  must  prevail.  Have 
we  not  fully  escaped  from  the  domination  of  the  old  doctrine 
as  to  the  lowering  treatment  of  inflammation,  or  are  there 
valid  reasons  why  we  should  be  less  bold  in  feeding  our 
typhoid  patients  than  our  chronic  febrile  consumptives? 
Three  such  reasons  deserve  special  consideration.  In  the  first 
place,  typhoid  is  far  more  frequently  a  self-limited  disease 
than  is  phthisis ;  but  the  fact  of  a  self -limitation  does  not  seem 
to  me  to  warrant  us  in  underfeeding,  for  the  less  the  patient 
loses  the  less  does  he  require  to  regain.  In  the  second  place, 
typhoid  has  constant  intestinal  lesions  which  may  bleed  or 
perforate,  and  which  may  be  accompanied  by  a  general 
catarrhal  state  of  the  intestinal  tract.  I  may  perhaps  add 
here  that  diarrhoea  is  not  nearly  as  constant  a  symptom  in 
typhoid  fever  as  the  books  lead  students  to  believe.  In  at 
least  50  per  cent,  of  my  hospital  cases  no  diarrhoea  was  pres- 
ent at  any  time.  We  must  therefore  have  reference  to  the 
local  intestinal  lesions  as  well  as  to  the  general  state.  In 
a  disease  of  such  long  course  it  is  impossible  to  prevent  acci- 
dents by  putting  the  bowels  in  splints,  even  if  it  were  de- 
sirable to  do  so.  More  or  less  peristalsis  must  go  on,  and 
waste  matter  must  pass  over  the  ulcerated  surfaces ;  and  how 
deep  or  extensive  the  ulcerated  surface  may  be  in  any  par- 
ticular case  no  symptom  or  group  of  symptoms  enables  us  to 
measure.  Hence,  it  seems  rational,  quite  apart  from  the 
fever,  to  withhold  from  the  diet  any  articles  the  residue  of 
which  is  liable  to  irritate  either  the  mucous  membrane  in 


344 


DIET  IN  DISEASE 


general  or  the  ulcerated  portion  in  particular.  This  would 
seem  a  fair  explanation  for  the  popularity  of  milk  as  a  diet 
for  typhoid^  containing  as  it  does  a  large  proportion  of  water, 
and  every  principle  necessary  to  nutrition,  so  combined  as  to 
make  relatively  small  demands  on  the  digestion  of  most  per- 
sons, and  leaving  a  residue  which,  though  notoriously  large, 
is  not  mechanically  irritating.  The  objection  to  milk  is  that 
it  is  repugnant  to  a  few  persons,  and  becomes  either  repugnant 
or  monotonous  to  a  considerable  number  sooner  or  later.  It 
is  not  necessary  here  to  specify  the  many  expedients  which 
may  and  often  must  be  resorted  to  to  overcome  this  objection, 
and  in  some  cases  to  render  it  digestible  w^hether  palatable  or 
not.  Milk  is  likely  to  maintain  a  very  important,  perhaps 
leading  place  in  the  diet  of  typhoid,  as  well  as  of  other  dis- 
eases and  conditions.  For  a  number  of  years  I  adhered  as 
strictly  as  possible  to  an  exclusively  milk  diet  in  typhoid 
fever  until  at  least  a  week  had  elapsed  from  the  date  of  the 
first  normal  evening  temperature.  I  closed  my  ears  to  the 
clamors  of  adults,  and  my  eyes  and  heart  to  the  tears  of 
children,  as  I  now  believe,  unnecessarily.  Thirdly,  it  was 
only  comparatively  recently  the  general  opinion  of  the  pro- 
fession that  relapse  is  or  may  be  due  to  errors  in  diet.  I 
well  remember  the  time  when  a  fresh  access  of  fever  led  my 
teachers  and  me  to  carefully  inquire  into  the  kindness  of 
officious  friends.  It  was  often  proved  that  forbidden  fruit 
actually  or  metaphorically  had  been  brought  in  by  a  visitor, 
and  this  was  an  entirely  satisfactory  explanation.  When 
proof  could  not  be  had,  the  fact  of  relapse  was  strong  pre- 
sumptive evidence  of  sin.  We  know  better  now,  and  while 
we  recognize  that  errors  in  diet  may  produce  fever,  as  may 
fatigue  or  excitement  in  convalescence  from  any  severe  dis- 
ease, we  do  not  believe  that  they  can  start  up  a  fresh  invasion 
of  bacilli  from  within.  One  of  the  things  which  set  me 
thinking  on  this  question  of  the  diet  in  typhoid  was  the 
favorable  course  run  by  several  acute  febrile  cases  for  whom  I 
ordered  a  full  diet  because  they  were  weak;  believing  at  the 
time  of  so  doing  that  typhoid  could  be  excluded,  but  being 


FEVERS  AND  INFECTIOUS  DISEASES  345 


forced  to  the  conclusion  later  that  only  typhoid  fever  could 
explain  the  whole  course  of  the  disease.  These  patients  did 
perfectly  well^  were  happier  and  convalesced  more  rapidly 
than  my  recognized  typhoid  cases  fed  exclusively  on  milk. 
For  five  years  now,  I  have  been  enlarging  the  diet  of  my 
typhoid  cases,  and  have  seen  no  reason  to  regret  this  course, 
but,  on  the  contrary,  found  cause  for  satisfaction. 

During  the  twelve  years,  1886  to  1897  (both  inclusive), 
380  cases  of  typhoid  fever  have  come  under  my  personal  care 
in  the  Massachusetts  General  Hospital.  Prom  1886  to  1893, 
233  cases  were  treated  under  a  milk  diet,  with  a  mortality 
of  10  per  cent.  Prom  1892  to  1897,  147  cases  have  been 
treated  under  a  much  more  extended  diet  with  a  mortality  of 
8.1  per  cent.  I  know  well  the  liability  to  reach  false  conclu- 
sions in  reasoning  from  too  small  figures  in  a  disease  like 
typhoid  fever.  And  it  is  also  true  that  water  has  been  used 
more  efficiently  of  late  than  in  former  years.  But  I  can 
see  nothing  in  my  figures  to  contravene  my  observation  that 
an  enlarged  diet  has  not  been  injurious.  I  would  not  be 
understood  as  advocating  an  indiscriminate  diet.  My  plea 
is  simply  for  treating  the  patient  rather  than  the  disease; 
for  feeding  him  with  reference  to  his  digestive  power  rather 
than  solely  or  mainly  with  reference  to  his  fever;  for  the 
view  that  the  danger  of  accidents  from  the  local  intestinal 
ulceration  is  not  increased  by  allowing  him  to  partake  of 
articles  which  leave  no  irritating  residue,  and  which  cautious 
trial  shows  are  digested  without  disturbance  or  discomfort. 
At  one  end  of  the  scale  are  the  cases  with  such  irritability 
or  weakness  of  the  stomach  as  to  lead  to  the  unfortunate  term 
gastric  fever,  or  those  with  pronounced  diarrhoea  and  un- 
digested food  in  the  stools;  at  the  other  end  are  those  more 
numerous  cases  with  clean  tongue  and  a  desire  for  food. 
Between  the  two  is  every  gradation.  The  life  of  the  former 
may  depend  on  the  skill  and  ingenuity  of  the  doctor,  as- 
sisted by  the  intelligent  devotion  of  the  nurse.  The  com- 
fort and  the  duration  of  disability  of  all  others  may  be 
materially  modified  for  good  by  careful  study  and  wise  in- 


346 


DIET  IN  DISEASE 


dividualization  of  our  cases.  A  long  list  of  permissible  ar- 
ticles^ from  which  selection  can  be  made  for  different  cases, 
and  for  the  same  case  at  different  times  under  varying  cir- 
cumstances, can  be  given.  That  which  I  append  makes  no 
claim  to  completeness,  but  is  meant  merely  to  be  suggestive 
and  illustrative : 

1.  Milk,  hot  or  cold,  with  or  without  salt,  diluted  with  lime  water, 
soda  water.  White  Rock  Water,  Vichy;  peptogenic  and  peptonised 
milk;  cream  and  water  (i.  e.,  less  albumin),  milk  with  white  of  egg, 
slip  buttermilk,  kumyss,  matzoon,  milk  whey,  milk  with  tea,  coffee, 
cocoa. 

2.  Soups:  beef,  veal,  chicken,  tomato,  potato,  oyster,  mutton,  pea, 
bean,  squash;  carefully  strained  and  thickened  with  rice  (powdered), 
arrowroot,  flour,  milk  or  cream,  egg,  barley. 

3.  Horlick's  food,  malted  milk,  carnipeptone,  bovinine,  somatose. 

4.  Beef  juice. 

5.  Gruels:  strained  cornmeal,  crackers,  flour,  barley-water,  toast- 
water,  albumin,  water  with  lemon- juice. 

6.  Ice  cream.    Water  ice. 

7.  Eggs,  soft  boiled  or  raw,  egg-nog. 

8.  Finely  minced  lean  meat,  scraped  beef.  The  soft  part  of  raw 
oysters.  Soft  crackers  with  milk  or  broth.  Soft  puddings  without 
raisins.  Soft  toast  without  crust.  Blanc-mange,  wine  jelly,  apple 
sauce  and  macaroni. 

TONSILITIS  AND  QUINSY 

Thompson  i 

Dietetic  Treatment.  These  diseases  require  no  special  care 
in  the  acute  stage,  beyond  giving  food  in  such  fluid  form  as 
oan  be  most  easily  swallowed.  The  pain  caused  by  this  act 
is  often  so  extreme  that  it  is  advisable  to  concentrate  all  food, 
to  lessen  the  number  of  necessary  acts  of  deglutition.  Meat 
juice,  peptonoids,  beaten  eggs  and  brandy,  may  be  added  to 
good  milk.  Plain  vanilla  ice  cream  may  be  given.  Its  cold- 
ness is  sometimes  soothing  to  the  pharynx. 

Holding  cracked  ice  in  the  mouth  before  swallowing  will 
sometimes  annul  the  pain  momentarily,  or  in  extreme  cases 
the  pharynx  and  tonsils  may  be  sprayed  with  cocaine^  and  the 

^  W.  Gilman  Thompson,  M.D. :  "Practical  Dietetics."  New  York.  D. 
Appleton  &  Co. 


FEVERS  AND  INFECTIOUS  DISEASES  347 


period  of  temporary  anaethesia  may  be  utilized  for  swallowing 
considerable  nourishment.  This  is  rarely  necessary^  for  un- 
less the  patient  is  emaciated  by  previous  serious  illness,  he  is 
not  apt  to  be  in  need  of  much  food  for  a  day  or  two.  In  bad 
cases  of  suppurative  tonsilitis  the  strength  suffers  more,  and 
stimulants  may  be  given  by  the  rectum  if  deglutition  is  im- 
possible. 

After  all  forms  of  tonsilitis  there  is  apt  to  be  considerable 
anaemia,  and  the  patient  for  a  week  or  two  should  eat 
abundantly  of  animal  food.  Egg-nog  and  milk  punches  are 
often  needed  for  the  first  few  days  of  convalescence. 

DIPHTHERIA 

Thompson  i 

Dietetic  Treatment.  "  Alimentation  occupies  the  first 
place  in  the  general  treatment (Trousseau).  Throughout 
the  active  stage  of  the  disease,  while  the  fever  lasts,  there  is 
difficulty  in  swallowing.  All  food  must  be  given  in  fluid 
form,  of  which  milk  is  the  best,  or  if,  as  sometimes  happens, 
semi-solid  material  is  more  easily  swallowed,  the  food  must 
be  thickened  with  cream,  gelatin,  eggs,  or  farinaceous  articles ; 
or  Dry  Peptonoids  Soluble,  malted  milk,  etc.,  may  be  added 
for  this  purpose  to  other  foods.  The  use  of  pineapple  juice 
is  recommended  because  it  contains  an  enzyme  which  belongs 
to  the  proteolytic  group. 

The  diet  should  consist  chiefly  of  nutritious  beef  or  chicken 
broth  and  beef  tea,  egg  albumin,  egg-nog,  milk,  and  milk 
punch.  Plain  vanilla  ice  cream  is  nutritious,  and  if  not  too 
sweet,  it  is  well  borne,  and  is  frequently  very  grateful  to  the 
inflamed  throat.  Simple  farinaceous  foods,  such  as  arrow- 
root, thoroughly  cooked  rice,  soft  cream,  toast,  and  gruels, 
may  be  taken.  Continued  disgust  for  food  is  a  very  bad 
prognostic  sign,  and  every  effort  must  be  made  to  counteract 
it  by  offering  variety.  When  the  child  is  unable  to  sw^allow 
on  account  of  pain  in  accumulation  of  membrane  in  the 

^  W.  Gilman  Thompson,  M.D. :  "Practical  Dietetics."  New  York.  D. 
Appleton  &  Co. 


348 


DIET  IN  DISEASE 


throaty  forced  feeding  with  a  nasal  or  stomach  tube  may  be 
better  than  nutrient  enemata. 

PNEUMONIA 

Thompson  i 

Dietetic  Treatment.  The  indications  for  treatment  are  to 
give  a  light  diet^  which  will  not  excite  the  cough  in  swallow- 
ing, or  increase  dyspnoea  by  distention  of  the  stomach,  or 
augment  the  enfeeblement  of  the  heart  action  by  overtaxing 
the  digestive  powers.  Vomiting  should  be  especially  guarded 
against,  and  if  nausea  exists,  efforts  should  be  made  at  once 
to  control  it.  It  is  not  necessary  to  keep  the  patient  upon  a 
rigid  milk  diet,  but  if  milk  is  well  borne,  it  is  advisable  to 
give  nothing  else  while  the  acute  symptoms  last;  otherwise, 
whey,  meat  juice,  broths,  and  egg  albumin  may  be  allowed. 
Starchy  and  saccharine  food  must  be  withheld.  Cold  drinks 
are  both  acceptable  and  beneficial  to  the  patient,  and  water 
plain  or  aerated,  such  as  ApoUinaris  or  soda  water,  may  be 
drunk  in  considerable  quantity.  It  is  believed  by  some  au- 
thorities that  the  activity  of  the  kidneys  may  be  thus  pro- 
moted, and  that  the  poison  which  occasions  the  constitutional 
symptoms  of  the  disease  may  be  better  eliminated.  There  are 
cases,  however,  among  persons  with  robust  circulation,  in 
which  the  onset  is  very  sudden  and  violent.  The  pulse  is 
full  and  bounding,  and  the  heart  is  greatly  overworked  by 
the  effort  to  propel  a  large  volume  of  imperfectly  aerated 
blood.  In  such  instances  the  addition  of  large  quantities  of 
fluid  to  the  circulation,  besides  what  is  actually  required  for 
nutrition,  may  have  the  effect  of  still  further  straining  the 
heart. 

It  is  stated  that  carbonated  waters  reduce  the  viscidity  of 
the  sputum,  which  is  often  very  tenacious. 

The  diet  should  be  kept  fluid  until  defervescence  has  oc- 
curred, with  a  normal  temperature  and  commencing  disap- 
pearance of  the  exudation  —  in  fact,  it  is  well  to  prolong 

^W.  Gilman  Thompson,  M.D. :  "Practical  Dietetics."  New  York.  D. 
Appleton  &  Co. 


FEVERS  AND  INFECTIOUS  DISEASES  349 


the  fluid  diet  for  three  or  four  days  after  the  temperature 
has  become  normal^  in  order  to  make  sure  that  a  relapse  of 
the  fever  is  not  likely  to  follow.  In  those  cases  in  which 
resolution  is  postponed,  and  the  patient  becomes  more  and 
more  feeble,  although  the  temperature  may  be  nearly  or  quite 
normal,  it  may  be  desirable  to  give  a  little  properly  prepared 
solid  food  somewhat  earlier,  and  scraped  beef,  with  toast,  or 
a  soft-cooked  egg  may  be  added  to  the  milk  diet. 

During  the  entire  period  of  convalescence  the  diet  must 
be  very  nourishing  and  of  easy  digestion;  milk  may  still  be 
given,  and  after  slowly  returning  to  the  regulation  three  meals 
a  day  (see  Diet  in  Convalescence  from  Typhoid  Fever,  p. 
339,  patients  do  well  to  take  milk  punch,  or  egg-nog,  or  a 
glass  of  wine  and  a  biscuit  three  or  four  times  a  day  in  the 
intervals. 

Alcohol  is  exceptionally  well  borne,  and  it  undoubtedly 
serves  both  as  a  food  and  a  support  to  the  overworked  heart. 
The  fact  that  it  is  thoroughly  oxidized  in  the  circulation  or 
tissues  is  demonstrated  by  the  large  quantities  which  patients 
can  often  digest  and  absorb  without  toxic  symptoms.  Doses 
may  be  thus  tolerated  which  in  health  would  ordinarily  pro- 
duce drunkenness.  In  alcoholic  subjects  who  have  been  drink- 
ing up  to  the  time  of  the  onset  of  the  disease,  it  is  indispen- 
sable to  continue  the  use  of  alcohol,  for  the  sudden  withdrawal 
of  its  stimulating  effect  on  the  organism  may  give  rise  to 
rapid  collapse.  In  aged  and  constitutionally  weak  persons  it 
is  also  important  that  its  use  should  be  begun  early  in  con- 
siderable quantities. 

In  extreme  cases  as  much  as  an  ounce  every  two  hours,  or 
twelve  ounces  in  the  day,  may  be  given  with  benefit,  but 
ordinarily  from  six  to  eight  ounces  will  suffice.  There  are 
other  cases  found  among  robust  subjects  who  do  not  need 
such  stimulating,  and  possibly  may  not  require  alcohol  at 
all.  The  custom  now  in  vogue  of  prescribing  other  forms  of 
cardiac  stimulants,  such  as  strychnine  and  vasodilators,  like 
nitroglycerin,  makes  the  employment  of  excessive  doses  of 
alcohol  less  imperative.    It  should  always  be  remembered 


350 


DIET  IN  DISEASE 


that  it  is  undesirable  to  produce  toxic  symptoms  of  alcoholism 
in  pneumonia^  as  well  as  in  any  other  disease.  So  long  as 
the  pulse  is  slowed  and  its  force  strengthened,  the  use  of 
alcohol  may  be  regarded  as  beneficial;  but  if  delirium  is  in- 
creased^ and  the  odor  of  whiskey  or  brandy  is  strong  in  the 
breath  an  hour  or  two  after  it  has  been  given,- it  is  an  indi- 
cation that  the  patient  is  receiving  more  than  is  desirable, 
and  the  dosage  should  be  reduced.  From  its  serving  as  a 
fuel,  and  thereby  saving  tissue  waste  in  the  muscles,  the  free 
use  of  alcohol  in  pneumonia  undoubtedly  saves  many  lives. 

BRONCHO-PNEUMONIA 

Thompson  i 

Dietetic  Treatment.  Broncho-pneumonia  is  always  a  very 
critical  disease,  and  the  utmost  care  is  required  in  nursing 
and  feeding.  The  diet  should  consist  of  such  articles  as 
meat  juice,  predigested  milk,  and  egg  albumin.  Stimulation 
is  early  required,  and  in  considerable  quantity.  Brandy  or 
whiskey,  sweetened  with  a  little  sugar,  and  cold  water,  should 
be  systematically  given,  especially  to  young  children,  who 
are  unable  to  make  their  want  of  drink  known.  Hot  milk  and 
Vichy,  in  the  proportion  of  one  part  of  Vichy  to  two  of 
milk  for  older  children,  or  half-and-half  for  young  infants, 
may  have  the  efl^ect  of  loosening  the  tenacious  mucous  and 
easing  the  cough.  If  there  is  any  tendency  to  flatulency, 
aerated  waters  had  better  be  avoided.  When  the  disease  oc- 
curs in  children  the  diet  should  be  adapted  to  foster  the 
strength  and  tax  the  digestive  organs  as  little  as  possible. 
At  first  food  should  be  given  every  two  hours,  and  milk  is 
usually  all  that  is  required.  Later  it  may  be  alternated  with 
or  supplemented  by  egg  albumin,  expressed  meat  juice,  plain 
beef  or  mutton  broths,  arrowroot,  or  other  gruels. 

MUMPS 

Thompson  i 

For  mumps  no  special  diet  is  required,  beyond  the  neces- 
sity of  giving  fluids  or  soft  food  while  the  swelling  of  the 

^  W.  Gilman  Thompson,  M.D. :  "Practical  Dietetics."  New  York.  D. 
Appleton  &  Co. 


FEVERS  AND  INFECTIOUS  DISEASES  351 


parotid  glands  and  fever  last.  The  suggestions  for  the  die- 
tetic treatment  of  tonsilitis  apply  to  this  disease.  Anaemia 
is  apt  to  be  extreme  during  convalescence,  and  meat  should 
therefore  be  plentifully  supplied.  Cod-liver  oil  is  very  ap- 
propriate in  protracted  convalescence. 

WHOOPING  COTJGH 

Thompson  i 

In  whooping  cough  the  paroxysms  of  coughing  are  so 
severe  as  to  give  rise  to  vomiting,  and  in  bad  cases  they  are 
excited  by  taking  food  which  does  not  have  an  opportunity 
to  become  assimilated,  and  nutrition  may  suffer  very  seriously 
in  consequence,  adding  to  the  general  exhaustion  which 
accompanies  the  disease.  All  food  must  be  made  easily  as- 
similable. It  is  best  to  give  food  regularly  in  moderate  quan- 
tity at  each  time,  and  it  should  be  predigested  if  neces- 
sary. Pancreatinised  milk,  kumyss,  the  prepared  amylaceous 
foods,  cream  toast,  eggs,  junket,  chicken  broth,  malted  farina- 
ceous foods,  custard,  milk  puddings,  gruels  thickened  with 
meat  extracts,  and  stimulants  in  the  form  of  egg  albumin  in 
sherry,  egg-nog  or  milk  punch,  are  recommended  for  patients 
who  vomit  solid  food.  The  worst  cases  require  nutrient 
enemata,  as  exhaustion  becomes  critical. 

DIET  IN  TTTBERCTILOSIS,  ESPECIALLY  PULMONARY  CONSUMP- 
TION 

Before  we  learned  of  the  contagious  character  of  this  affec- 
tion^ and  its  dependence  on  the  tubercle  bacillus,  it  was  the 
custom  to  regard  tuberculosis  as  a  disease  of  nutrition,  curable 
only  by  abundant  feeding  —  all  that  a  patient  could  tolerate 
—  and  especially  feeding  with  fats  and  mineral  matter.  Even 
in  modern  times  the  custom  of  overfeeding  is  largely  re- 
sorted to,  and  when  the  patient  has  but  little  appetite,  the 
stomach  sound  is  often  used  to  give  large  quantities  of  con- 
centrated liquid  food,  perhaps  predigested.  Many  physicians 
strongly  disapprove  of  this  practice^  claiming  that  it  is  utterly 

*W.  Oilman  Thompson,  M.D. :  "Practical  Dietetics."  New  York.  D. 
Appleton  &  Co. 


352 


DIET  IN  DISEASE 


irrational  and  throws  an  enormous  amount  of  extra  work  on 
the  organs  of  digestion^  assimilation  and  elimination. 

It  is  as  true^  as  ever^  that  a  full  diet  antagonizes  the  dis- 
ease. A  tuberculous  subject  or  one  likely  to  become  so,  is  not 
capable  of  much  physical  exertion,  and  save  in  the  hectic 
fever  stage,  has  not  much  temperature.  The  poison  of  the 
disease  deprives  him  of  a  natural  appetite,  and  unless  he  is 
able  to  assimilate  a  normal  amount  of  food,  he  loses  flesh 
progressively,  as  in  any  other  affection  with  loss  of  appetite 
or  indigestion.  Hence  his  diet  does  not  differ  much  from 
that  of  the  convalescent "  in  the  composition  of  food ;  but 
on  account  of  the  enfeebled  appetite  and  digestion  the  in- 
dividual articles  best  borne  are  those  used  in  severe  indiges- 
tion from  any  cause.  That  is,  they  are  to  be  concentrated, 
bland,  and  as  varied  as  possible.  As  in  dyspepsia,  the  pa- 
tient does  best  on  small  and  frequent  meals. 

Considerable  use  can  be  made  of  milk,  cream,  buttermilk, 
kumyss,  etc.  The  remarkable  and  inexplicable  curative  effects 
of  a  certain  amount  of  fat  in  the  diet  should  never  be  for- 
gotten. The  frequent  repugnance  to  fat  has  in  fact  been 
connected  with  the  development  of  disease.  This  distaste 
does  not  usually  extend  to  cream,  butter  and  salad  oil,  and 
many  forms  of  emulsions  of  fat  with  or  without  hypophos- 
phites  have  a  deserved  reputation.  So  important  is  a  cer- 
tain amount  of  fat  that  many  physicians  have  it  rubbed  into 
the  skin  and  even  injected  subcutaneously.  The  patient  is 
not  limited  to  a  fixed  daily  quantity,  but  is  given  as  much  as 
he  can  tolerate.  A  certain  amount  of  alcohol  in  some  form 
is  so  well  borne  in  tuberculosis  as  to  make  it  a  dietetic  article 
of  value.  It  is  probable  that  both  fat  and  alcohol  act  by 
protecting  the  protein.  Both  have  a  high  caloric  value,  so 
that  the  amount  of  other  nutriment  can  be  restricted,  and 
should  consist  largely  of  eggs,  milk  and  an  occasional  piece 
of  tender  meat. 

For  an  average  consumptive,  without  fever,  but  with  no 
desire  for  food,  six  small  meals  may  be  given  daily. 


FEVERS  AND  INFECTIOUS  DISEASES  353 

1.  8  A.  M.  Milk^  taken  slowly^  two  glasses,  with  a  roll  or 
toast  and  butter  and  a  little  marmalade. 

2.  10  A.  M.    Milk  punch,  taken  slowly. 

3.  1  P.  M.  A  course  dinner  may  be  given  for  the  sake  of 
variety:  cup  of  broth,  a  few  bites  each  of  fish,  beef,  potato 
and  anything  else  craved  as  an  entree  (as  a  bit  of  smoked 
tongue).  Also  a  mouthful  or  two  of  some  kind  of  dessert. 
The  patient  may  aid  the  appetite  by  taking  wine,  or  some 
form  of  malt  liquor. 

4.  4  P.  M.    Two  glasses  milk  slowly  sipped. 

5.  7  p.  M.  Like  dinner,  but  much  smaller.  A  plate  of 
soup,  a  chop  and  a  little  preserve  with  a  glass  of  wine. 

6.  Bed  time.    Two  glasses  of  milk  slowly  sipped. 

In  this  way  up  to  2500  calories  may  be  taken  without  over- 
feeding. If  a  patient  technically  tuberculous,  but  with  good 
appetite  and  digestion  can  take  3000  to  3500  calories  daily 
without  discomfort,  he  may  do  so,  even  though  his  quiet  life 
would  not  otherwise  make  such  a  quantity  desirable.  The 
fat  and  alcohol  which  help  so  materially  to  swell  the  number 
of  calories  tend  to  fortify  the  body  against  the  progress  of 
the  disease. 

On  the  other  hand,  patients  in  advanced  or  confirmed 
phthisis  can  hardly  be  saved  by  any  plan  of  feeding.  They 
often  suffer  from  severe  complications  like  incessant  diarrhoea 
or  laryngeal  phthisis  which  make  any  plan  of  feeding  difficult. 
Each  case,  therefore,  must  be  a  law  to  itself.  The  modern 
-custom  is  to  feed  them  all  they  can  tolerate,  especially  of 
solid  food,  to  supply  energy,  for  the  paroxysms  of  coughing 
and  the  exertion  necessary  to  dress  and  get  about  in  the  out- 
door air. 

DIET :  Soups. —  Turtle  or  oyster  soup,  mutton,  clam  or  chicken 
broth,  puree  of  barley,  rice,  peas,  beans,  cream  of  celery  or  tomatoes, 
whole  beef  tea,  peptonised  milk  gruel. 

Fish. —  All  kinds  of  fresh  fish,  boiled  or  broiled,  oysters  or  clams, 
raw,  roasted  or  broiled. 

Meats. —  Rare  roast  beef  or  mutton,  lamb  chops,  ham,  fat  bacon, 
sweetbreads,  poultry,  game,  tender  steaks,  hamburger  steak  rare. 


354 


DIET  IN  DISEASE 


Eggs. —  Every  way  except  fried. 

Farinaceous. —  Oatmeal,  wheaten  grits,  mush,  hominy,  rice,  whole 
wheat  bread,  corn  bread,  milk  toast,  biscuits,  muffins,  gems. 
Fats. —  Cream,  butter,  olive  oil. 

Vegetables. —  Potatoes,  baked,  boiled  or  creamed,  string  beans, 
spinach,  onions,  asparagus,  tomatoes,  green  peas,  all  well  cooked, 
cresses,  lettuce  (alone  or  with  oil  dressing),  celery. 

Desserts. —  Farina,  sago,  tapioca,  apple  or  milk  pudding,  floating 
island,  custards,  baked  or  stewed  apples  with  fresh  cream,  cooked 
fruits,  rice  with  fresh  cream. 

Liquids. —  Fresh  milk,  cool,  warm,  or  peptonised,  cocoa,  chocolate, 
buttermilk,  pure  water,  tea,  coffee. 

AVOID. —  Fried  foods,  salt  fish,  hashes,  gravies,  veal,  pork,  carrots, 
parsnips,  cabbage,  beets,  turnips,  cucumbers,  macaroni,  spaghetti, 
sweets,  pies,  pastry,  sweet  wines. 


CHAPTEE  XV 


DIET  IN  DISORDERS  OF  NUTRITION 

DIET  IN  DIABETES 

It  is  commonly  believed  that  diabetes  should  be  managed 
dietetically  by  a  sugar-and-starch-free  regimen^  carried  to 
such  a  degree  that  excess  of  sugar  no  longer  appears  in  the 
urine.  As  a  matter  of  fact^  such  teaching  may  be  very  mis- 
leading. A  diabetic,  in  the  early  stages  at  least,  must  lead 
a  fairly  active  life,  and  requires  the  usual  number  of  calories 
for  such  living.  If  sugars  and  starches  are  removed  wholly 
from  the  diet,  the  requisite  calories  must  be  derived  from 
protein  and  fat,  and  this  may  prove  a  strain  both  on  the 
desire  for  food  and  its  digestion  and  utilization.  It  is  there- 
fore rational  to  allow  a  certain  percentage  of  carbohydrates, 
as  they  occur  in  such  common  articles  of  food  as  bread, 
cereals,  potatoes,  etc.,  even  if  they  favor  the  appearance  of 
sugar  in  the  urine.  We  know  that  in  this  disease,  the  starch 
and  sugar  in  the  diet  becomes  a  poison  if  carried  beyond  a 
certain  stage.  The  tissues  then  become  saturated  with 
saccharine  products^  and  readily  succumb  to  chance  infec- 
tions, the  microbes  of  which  behave  as  they  do  in  sweetened 
culture  media.  But  in  a  vigorous  subject  leading  an  active 
life,  there  is  always  a  point  within  which  the  bodily  activities 
are  sufRcient  to  oxidize  most  of  the  carbohydrate  intake ;  and 
a  certain  amount  of  escape  of  excess  products  in  the  urine  is 
then  relatively  insignificant. 

A  characteristic  diet  is  as  follows : 

(a)  First  Breakfast.  This  should  consist  of  lean  and  fat 
meat,  such  as  occurs  naturally  in  ham  or  bacon.  For  a  bev- 
erage we  may  give  coffee  sweetened  with  saccharine.  If  there 
is  a  craving  for  bread,  starch-free  gluten  bread  should  be 
added. 

355 


356 


DIET  IN  DISEASE 


(b)  Second  Breakfast.  Cream^  eggs,  beef  juice,  kumyss, 
or  other  liquid  or  semi-liquid  food. 

(c)  Noon  Meal.  A  course  dinner,  beginning  with  broth 
enriched  with  an  egg,  meat,  or  bits  of  green  vegetable.  To 
this  should  be  added  small  portions  of  fish,  roast,  entree,  game, 
etc.  As  extras,  salad,  cheese,  etc.  Wine,  etc.  A  small 
amount  of  bread  and  butter  and  potatoes  if  craved. 

First  Evening  Meal.  Coffee  and  cream,  sweetened  with 
saccharine.    An  egg  added  if  craved. 

Second  Evening  Meal.  This,  usually  served  at  bed  time, 
is  meant  to  give  the  patient  a  chance  to  make  up  for  de- 
ficiencies. He  may  indulge  especially  in  sapid  food,  as  fish, 
oysters,  clams,  caviare,  sardines,  etc.,  with  plenty  of  salad 
vegetables.  Bread  and  butter,  cheese,  nuts,  etc.,  if  craved 
during  the  meals  of  abstention  may  be  given  if  allowed. 

The  foregoing  7}ie7iu  is  intended  for  those  stages  of  the 
disease  in  which  the  patient  profits  by  some  use  of  carbohy- 
drates. With  the  advance  of  the  affection,  a  point  is  reached 
at  which  such  foods  are  actually  pernicious.  It  then  becomes 
a  problem  to  nourish  these  individuals  with  a  diet  practically 
free  from  sugars  and  starches.  It  is  only  necessary  for  the 
nurse  to  have  at  hand  tables  of  food  containing  the  exact 
percentage  of  carbohydrates ;  for  in  this  way  she  may  protect 
the  sufferer. 

A  point  is  reached  at  last  in  which  a  certain  excess  of  carbo- 
hydrates may  precipitate  a  fatal  termination. 

DIABETIC  DIET  OF  BELLEVTJE  HOSPITAL  i 

Meat. —  Fat  beef,  mutton,  ham  and  bacon. 

Fish. —  Fresh  fish,  salted  codfish,  canned  salmon,  sardines,  oysters 
and  clams. 

Farinaceous. —  Gluten  bread  and  biscuits. 

Vegetables. —  String  beans,  spinach,  lettuce  with  olive  oil  and 
vinegar,  cabbage,  cucumbers,  onions,  tomatoes,  cauliflower,  asparagus, 
celery,  watercress,  radishc",  pickles  and  olives.    Cream  cheese. 

Dessert. —  Custards,  jellies  and  creams  (without  sugar),  walnuts, 
Brazil  nuts  and  pecans. 

Drinks. —  Tea  or  coffee  without  sugar,  water  and  buttermilk. 

1  Diet  used  at  Bellevue  Hospital,  New  York. 


DISORDERS  OF  NUTRITION  357 


DIABETIC  DIET  OF  PRESBYTERIAN  HOSPITAL  i 

Buttermilk,  kumyss,  beef  tea,  coffee,  cocoa,  tea,  saccharine 
in  lieu  of  sugar,  clams  (thin  soup),  fish,  poultry,  beef,  mutton, 
bacon,  eggs,  string  beans,  cabbage,  tomatoes,  lettuce,  spinach 
greens,  lemons,  apples,  oranges,  strawberries. 

No  milk  or  sugar, 

DIABETIC  DIET  OF  THE  MASSACHUSETTS  GENERAL  HOSPITAL  2 

DIET. —  Meats  of  all  kinds  (except  liver),  fish  except  lobsters  or 
oysters,  poultry,  game,  eggs,  cheese,  butter,  lettuce,  celery,  cucum- 
bers, watercress,  dandelions,  young  onions,  cabbage,  cauliflower, 
spinach,  beet-tops,  string  beans,  artichokes,  filberts,  mushrooms, 
almonds,  butternuts,  walnuts,  cocoanut,  sour  oranges,  grape  fruits, 
currants,  alkaline  waters. 

AVOID. —  Sugar,  syrup  of  all  kinds,  potatoes,  beets,  peas,  parsnips, 
carrots,  beans,  arrowroot,  sago,  tapioca,  oatmeal,  barley,  sweet  fruits, 
chocolate,  cider,  malt  liquors,  champagne,  sparkling  or  sweet  wines- 
and  milk. 

STRICT  SUGAR-FREE  DIET  2 

(Diabetic  Diet) 

Diabetic  Diet  (Strict  —  Sugar-free).  Contains  about  20  gms.  of 
carbohydrates,  calories  2800,  proteid  1 10  gms. 

Breakfast. —  Bacon,  100  gms.;  eggs,  2;  orange,  1;  coffee  with  saccha- 
rine and  cream.    11  A.  M.,  Cheese:  cream  or  Swiss,  50  gms. 

Noon, —  Beef,  veal,  lamb  or  chicken,  100  gms. ;  lettuce  or  tomato  salad 
with  oil;  spinach,  onions,  cabbage  or  cauliflower,  olives;  cus- 
tard made  of  eggs  and  cream  with  saccharine  or  ice  cream 
made  the  same  way.    4  P.  m..  Soft  cooked  egg  with  butter. 

Supper. — 'Fish,  100  gms.;  cucumber  salad  with  oil;  asparagus  or  beet 
tops;  mushrooms,  nuts;  give  all  cream  and  butter  possible. 
Vary  diet  within  above  limits.  60  per  cent,  centrifugal  cream 
is  used,  diluted  with  water. 

At  start  give  above  diet  with  addition  of  200  gms.  bread. 
After  two  to  four  days,  decrease  bread  gradually  100  gms. — 
50  gms.  to  strict  diet. 

If  acidosis  increases  with  strict  diet,  give  large  doses  of 
soda.    Control  in  this  way,  and  by  changing  diet. 

If  patient  has  increasing  acidosis  on  strict  diet  add  soda  8 

^  Diet  iised  at  the  Presbyterian  Hospital,  New  York. 

2  Diet  used  at  the  Massachusetts  General  Hospital,  Boston,  Mass. 


358 


DIET  IN  DISEASE 


oz.  a  day^  try  method  of  starvation  one  day,  vegetable  diet 
(no  carbohydrate)  one  day,  oatmeal,  250  grammes  one  day, 
alternating.  The  same  plan  may  be  tried  if  there  is  failure 
to  get  sugar-free  urine  on  strict  diet;  but  first  try  plan  of 
cutting  down  protein  on  strict  diet,  replacing  protein  with 
more  cream  and  butter,  as  sugar  is  made  from  protein.  Keep 
on  strict  diet  one  month  after  using  sugar-free;  then  add 
bread  25  gms.,  etc. 

CHRONIC  DIABETES  DIET 

DIET. —  Soups:  Soups  or  broth  of  beef,  chicken,  mutton,  veal, 
oysters,  clams,  terrapin  or  turtle  (not  thickened  with  any  farinaceous 
substances),  beef  tea. 

Fish. —  Shell  fish  and  all  kinds  of  fish,  fresh,  salted,  dried,  pickled 
or  otherwise  preserved  (no  dressing  containing  flour). 

Eggs. —  In  any  way  most  acceptable. 

Meats.^ —  Fat  beef,  mutton,  ham  or  bacon,  poultry,  sweetbreads, 
calf's  head,  sausage,  kidneys,  pig's  feet,  tongue,  tripe,  game  (all 
cooked  free  of  flour,  potatoes,  bread  or  crackers). 

Farinaceous. —  Gluten  porridge,  gluten  bread,  gluten  gems,  gluten 
biscuits,  gluten  wafers,  gluten  griddle  cakes,  almond  bread  or  cakes, 
bran  bread  or  cakes. 

Vegetables. —  String  beans,  spinach,  beet-tops,  chicory,  kale,  let- 
tuce, plain  or  dressed  with  oil  and  vinegar,  cucumbers,  onions,  toma- 
toes, mushrooms,  asparagus,  oyster  plant,  celery,  dandelions,  cresses, 
radishes,  pickles,  olives. 

Desserts. —  Custards,  jellies,  creams  (without  any  sugar),  walnuts, 
almonds,  filberts,  Brazil  nuts,  cocoanuts,  pecans. 

Drinks. —  Tea  or  coffee  (without  any  sugar),  pure  water,  pepto- 
nised  milk,  buttermilk. 

AVOID. —  Liver,  sugars,  sweets  or  starches  of  any  kind,  wheaten 
bread  or  biscuits,  corn  bread,  oatmeal,  barley,  rice,  rye  bread,  arrow- 
root, sago,  macaroni,  tapioca,  vermicelli,  potatoes,  parsnips,  beets, 
turnips,  peas,  carrots,  melons,  fruits,  puddings,  pastry,  pies,  ices, 
honey,  jams,  sweet  or  sparkling  wines,  cordials,  cider,  porter,  lager, 
chestnuts,  peanuts. 

STJBSTITTJTES  FOR  STARCH  AND  SUGAR 

Chim  Gluten  Flour  can  be  made  into  bread  and  a  great  variety  of 
dishes,  and  is  the  most  satisfactory  substitute  for  the  wheat  flour 
bread  or  bread  in  common  use,  and  the  effects  are  particularly  no- 
ticeable in  the  reduction  of  sugar  in  the  daily  tests. 

Siueetina  is  in  the  pure  crystal  form,  and  is  made  into  a  syrup  by 


DISORDERS  OF  NUTRITION  359 


adding  cold  water.  Distilled  water  is  preferable.  It  is  sold  in  small 
bottles  at  25  cents  each,  the  contents  of  which  is  equal  to  eight  pounds 
of  sugar  in  sweetening  power. 

One  bottle  of  crystals  makes  one  pint  of  syrup,  of  which  a  tea- 
spoonful  is  equal  to  a  cupful  of  sugar. 

Sweetina  is  an  improved  product  from  coal  tar. 

A  DIABETIC  CHART 
Joslin  and  Goodall  i 

The  intelligent  management  of  a  case  of  diabetes  mellitus 
requires  frequent  comparisons  between  the  diet^  the  urinary- 
analyses  and  the  weight  of  the  patient.  These  data  are  often 
printed  or  written  down  in  four  or  five  different  places,  and 
the  labor  of  uniting  them  is  so  great  that  it  is  seldom  at- 
tempted. Any  accurate  study  of  a  case  is  thus  extremely 
difficult,  and  in  hospitals  past  records  are  almost  useless.  To 
facilitate  the  treatment  of  diabetic  patients  and  to  eliminate 
some  of  the  annoying  sources  of  error,  we  have  used  a  chart 
for  some  years  upon  which  some  of  these  facts  were  recorded. 
Our  chart  was  designed  chiefly  for  the  benefit  of  the  physician, 
in  contrast  to  the  charts  in  use  in  various  German  clinics, 
which  have  a  broader  application  and  are  of  direct  help  not 
only  to  the  physician,  but  also  to  the  nurse  and  the  patient 
as  well.  By  this  latter  arrangement  the  chart  becomes  the 
nurse^s  record,  and  upon  it  the  nurse  writes  what  the  patient 
actually  eats.  We  have  attempted  to  combine  the  two  meth- 
ods on  the  following  chart,  and  hope  that  it  will  be  found 
helpful  and  suggestive  in  the  treatment  of  diabetic  patients. 

Space  is  reserved  upon  the  chart  for  the  Doctor's  orders 
and  the  nurse's  record,  as  well  as  the  urinary  analyses. 
There  is  given,  in  addition,  a  statement  of  the  foods  com- 
monly allowed  in  a  strict  diabetic  diet,  with  the  percent  of 
carbohydrates  in  other  foods  which  are  occasionally  em- 
ployed. 

Diabetic  Chart  by  Elliott  P.  Joslin,  M.D.,  and  Harry  W.  Goodall, 
M.D.,  Boston,  Mass.  (Reprinted  from  the  Boston  Medical  and  Surgical 
Journal,  Vol.  clviii.  No.  8,  pp.  248-251,  Feb.  20,  1908.)  D.  C.  Heath  «& 
Co.,  120  Boylston  St.,  Boston,  Mass. 


360 


DIET  IN  DISEASE 


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Pro- 
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Total 
Carb. 

Urine 

Total 
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Pen- 
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DISORDERS  OF  NUTRITION  361 


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362 


DIET  IN  DISEASE 


MENUS  FOR  THE  DIABETIC 

SUMMER 

SUNDAY 
Breakfast 

Gluten  Breakfast  Food,  Scalloped  Eggs, 

Gluten  Muffins,  Coffee. 

Dinner 
Asparagus  Soup, 
Fricassee  Chicken  and  Dumpling, 
Creamed  Green  Onions,  Sliced  Tomatoes, 

Beet  Greens,  Cucumber  Salad, 

Baked  Custard,  Gum  Gluten  Dainty  Fluffs. 

Supper 
Chicken  Salad, 
Pimento  Cheese  Gluten  Sandwiches, 
Gluten  Nut  Cake,  Tea. 

MONDAY 
Breakfast 

Asparagus  Tip  Omelet.  Gluten  Pop-Overs, 

Coffee. 

Luncheon 

Baked  Gluten  Noodles,  Ripe  Olives  and  Radishes, 

Gluten  Bread,  Tea. 

Dinner 

Jellied  Chicken  Consomme, 
Gluten  Biscuit  Crisps, 
String  Beans,  Scalloped  Tomatoes, 

Egg  Salad  with  Cress,  Mayonnaise  Dressing, 
Coffee  Jelly,  Whipped  Cream, 
Demi  Tasse,  Gum  Gluten  Dainty  Fluffs. 

TUESDAY 
Breakfast 
Dainty  Fluffs  and  Cream, 
Fried  Perch  and  Cresses, 
Gluten  Gems,  Coffee. 

Luncheon 

Codfish  Croquettes,  Gluten  Drop  Biscuits, 

Sliced  Tomatoes,  Tea. 


DISORDERS  OF  NUTRITION  363 


Dinner 
Jellied  Consomme, 
Gluten  Bread, 

Scalloped  Tomatoes,  Spinach, 

Asparagus  Salad,  French  Dressing, 
Cheese  Souffle,  Boiled  Almond  Custards, 

Iced  Coffee,  Gum  Gluten  Dainty  Fluffs. 

WEDNESDAY 


Breakfast 
Tomato  Omelet, 

Gluten  Muffins, 

Luncheon 
French  Gluten  Toast, 
String  Bean  Salad,  French  Dressing, 
Gluten  Bread  Sticks, 

Dinner 
Jellied  Tomato  Consomme, 

Baked  Fish 

Creamed  Asparagus, 

String  Beans, 

Pineapple  Ice, 


Coffee. 


Iced  Tea. 


THURSDAY 
Breakfast 

Fried  Mackerel, 

Gluten  Bread, 

Luncheon 

Scalloped  Eggs, 
Olives, 

Gluten  Cheese  Sandwiches, 

Dinner 
Cream  Tomato  Soup, 

Broiled  Squab  on  Toast, 

Lettuce  Salad,  Spinach, 
Baked  Nut  Custard, 

FRIDAY 
Breakfast 

Gluten  Granules, 

Gluten  Drop  Biscuits, 


Gluten  Bread, 
Fried  Noodles, 

Demi  Tasse. 


Cresses, 

Coffee. 

Gluten  Wafers, 
Radishes, 

Tea. 


Gluten  Croutons, 
Sliced  Tomatoes, 
Coffee. 


lish  Omelet, 
Coffee. 


364 


DIET  IN  DISEASE 


Luncheon 


Cheese  Pudding, 
Gluten  Lettuce  Sandwiches, 


Olives, 


Tea. 


Dinner 
Cream  of  Spinach  Soup, 
Broiled  Shad, 

String  Beans,  Cucumbers^ 
Vegetable  Salad  with  Mayonnaise  Dressing, 
Gluten  Bread, 

Gluten  Fruit  Pudding,  Coffee, 


SATURDAY 
Breakfast 


Gluten  Breakfast  Food, 
Gluten  Gems, 


Fish  Croquettes, 
Coffee. 


Luncheon 
Aspic  Jelly  with  Tongue, 
Gluten  Lettuce  Sandwiches, 
Whipped  Cream  with  Nuts  on  Dainty  Fluffs, 
Tea, 


Dinner 
Clam  Broth, 
Gluten  Buttermilk  Bread, 
Asparagus  on  Gluten  Toast, 
Spinach, 


Lemon  Jelly, 


Gluten  Breakfast  Food, 
Gluten  Toast, 

Oysters, 


Coffee. 

WINTER 

SUNDAY 
Breakfast 

Dinner 


String  Beans, 
Baked  Onions, 
Gluten  Biscuit  Crisps, 


Roast  Beef, 

Celery, 

Salted  Almonds, 
Gum  Gluten  Dainty  Fluffs, 


Gluten  Bread, 

Spinach, 
Shrimp  Salad, 


Scrambled  Eggs, 
Coffee. 

Cream  Celery  Soup, 

Brussels  Sprouts, 
Olives, 


Baked  Custard, 


Coffee, 


DISORDERS  OF  NUTRITION 


365 


Supper 

Cream  Cheese  Duinty  Fluff  Sandwiches, 
Salmon  Pudding, 

Gluten  Nut  Cake,  Tea, 

MONDAY 
Breakfast 

Gluten  Granules,  Parsley  Omelet, 

Gluten  Muffins,  Coffee. 
Luncheon 
Broiled  Lobster,  Mayonnaise  Dressing, 
Gluten  Cream  Cheese  Sandwiches,  Tea. 

Dinner 

Consomme,  Gluten  Bread, 

Scalloped  Gluten  Noodles  and  Celery, 
Creamed  Cabbage,  String  Beans, 

Salmon  Salad  with  Mayonnaise, 
Pignolia  Nuts,  Olives, 
Coffee  Jelly  with  Whipped  Cream, 
Demi  Tasse. 

TUESDAY 
Breakfast 

Gluten  Griddle  Cakes,  Bacon  and  Eggs, 

Coffee. 
Luncheon 
Gluten  Noodles  au  Gratin, 
Cream  Cheese  and  Lettuce  Salad, 
Gluten  Nut  Bread,  Tea, 

Dinner 
Cream  of  Onion  Soup, 
Roast  Mutton,  Gluten  Bread, 

Creamed  Cauliflower,  Spinach, 
Fried  Sour  Apples,  Gluten  Cheese  Wafers, 

Gluten  Brown  Betty,  Coffee, 

WEDNESDAY 
Breakfast 

Ham  and  Eggs,  Gluten  Muffins, 

Coffee. 

Luncheon 

Clam  Broth,  Gluten  Biscuit  Crisps, 

Scalloped  Tomatoes, 
Gluten  Tea  Biscuits,  Tea, 


366 


DIET  IN  DISEASE 


Dinner 
Cream  of  Tomato  Soup, 
Roast  Chicken,  Gluten  Nut  Bread, 

Brussels  Sprouts,  Celery,  String  Beans, 

Gluten  Pudding,  Coffee, 

THURSDAY 
Breakfast 
Fried  Gluten  Breakfast  Food, 
Gluten  Pop-Overs,  Coffee. 

Luncheon 

Chicken  Salad,  Sour  Pickles, 

Gluten  Bread,  Tea. 

Dinner 

Little  Neck  Clams,  Mutton  Chops, 

Oyster  Plant,  Baked  Noodles, 

Sardine  Salad  with  French  Dressing, 
Fruit  Pudding,  Whipped  Cream, 
Gluten  Bread,  Demi  Tasse. 

FRIDAY 
Breakfast 

Gluten  Porridge,  Mackerel  with  Egg  Sauce, 

Gluten  Drop  Biscuits,  Coffee. 

Luncheon 

Scalloped  Oysters,  Gluten  Nut  Sandioiches, 

Cold  Slaw,  Tea. 

Dinner 

Baked  Fish,  Celery, 
Creamed  Cabbage,  Asparagus  on  Toast, 

Tomato  Jelly  Salad  tcith  Mayonnaise, 
Baked  Custard, 

Gluten  Buttermilk  Bread,  Coffee. 
SATURDAY 
Breakfast 

Gluten  Breakfast  Food,  Bacon  and  Eggs, 

Gluten  Muffins,  Coffee. 

Luncheon 
Fish  Croquettes, 

Grape  Fruit,  Gluten  Lettuce  Sandwiches, 

Tea. 


DISORDERS  OF  NUTRITION  367 


Oluten  Crisps, 
Cheese  Souffle, 
Celery, 


Coffee. 


LITHEMIA  OR  EXCESS  OF  TJRIC  ACID 


Treatment  for  Uric  Acid,  Exercise  in  the  open  air  — 
walk  —  plenty  of  fresh  air  by  night  as  well  as  by  day. 
Breathe  deeply.  Bathe  often ;  rub  the  body  thoroughly  after- 
ward; the  skin  should  play  an  important  part  in  elimination 
of  uric  acid. 

To  prevent  the  formation  of  an  over  supply  of  uric  acid, 
be  careful  of  diet.  The  first  thing,  do  not  eat  meat.  You 
may  eat  nuts  with  salt,  fresh  ripe  fruit;  best  of  all,  apples 
unpeeled;  all  cooked  fruits,  but  very  little  sugar  in  them; 
all  vegetables  that  grow  above  ground  (not  those  that  grow 
below  ground)  ;  greens  are  especially  good,  with  good  cider 
vinegar.  Bread  may  be  eaten  in  moderation,  graham  and 
entire  wheat  best,  good  water  crackers,  cereals  of  all  kinds ;  • 
eggs  should  be  used  sparingly,  and  in  severe  cases  not  at  all. 
Fish  is  good,  also  shellfish.  No  pastry  or  sweet  cakes;  milk 
and  cheese  may  be  used  freely,  also  buttermilk.  Drink  no 
coffee,  tea,  malt  or  alcoholic  liquors.  Drink  pure  water  and 
a  great  deal  of  it ;  sometimes  it  is  well  to  use  lithia  tablets. 


Dietetic  Treatment.  During  acute  attacks  the  diet  must 
be  restricted,  but  the  extent  of  restriction  will  depend  upon 
age,  habits  and  conditions  of  the  patient. 

Meat  and  alcohol  as  a  rule  are  excluded.  As  a  rule  it  is 
best  to  exclude  meat,  more  especially  red  meat,  and,  unless 
especially  necessary,  forbid  alcohol.  In  old  people,  with 
feeble  circulation,  accustomed  to  the  regular  and  free  use  of 
alcohol,  it  may  be  necessary  to  allow  a  small  amount.  If  the 
kidneys  be  seriously  at  fault  it  may  be  best  not  even  to  give 
small  amount  of  alcohol. 

For  the  young  and  strong  the  diet  should  consist  mainly 


ACUTE  GOUT 


368 


DIET  IN  DISEASE 


of  farinaceous  substances  and  broths,  made  not  too  strong, 
such  as  bread  and  milk,  a  cup  of  weak  tea  with  milk,  dry 
toast  with  a  little  butter,  vegetable  broths,  two  ounces  of  milk 
with  Vichy  water ;  rice,  sago,  semolina  or  an  farinaceous  pud- 
ding made  without  eggs. 

He  should  sip  half  a  pint  of  hot  water  twice  or  thrice 
daily  between  meals,  and  barley  water  and  toast  water  may 
be  allowed.  After  acute  symptoms  have  subsided,  boiled  fish 
and  a  little  chicken  may  be  given  once  a  day,  and  nourish- 
ment carefully  and  gradually  increased. 

For  old  or  feeble  persons  the  diet,  although  kept  in  same 
lines,  must  be  more  supporting;  have  broths,  etc.,  stronger, 
and  beef  juice,  chicken  broth  and  an  egg  beaten  up  in  a 
glass  of  milk  once  a  day.    Alcohol  may  also  be  necessary. 

In  protracted  cases  it  may  be  necessary  to  allow  more 
nutritious  diet,  including  fish,  soup  and  white  meats,  as  well 
as  an  allowance  of  brandy  or  whiskey. 

CHRONIC  GOUT 

DIET :  Soups. —  Clear  vegetable  broths,  fresh  fish  soup. 

Fish. —  Fresh  fish  broiled  or  boiled,  raw  oysters. 

Meats. —  Eat  of  all  kinds  sparingly,  game,  chicken,  fat  bacon. 

Farinaceous. —  Crackers,  dry  toast,  milk  toast,  macaroni,  graham 
bread  or  rolls,  rye  bread,  whole  wheat  bread,  or  biscuit,  cereals. 

Vegetables. —  Celery,  lettuce,  cresses,  cucumbers,  cabbage,  spinach, 
string  beans,  green  peas,  mashed  potatoes. 

Desserts. —  (All  without  sugar).  Plain  milk  puddings,  junket,  rice 
and  milk.    Stewed  fruits. 

Liquids. —  Pure  water,  hot  or  cold;  toast  water,  buttermilk,  milk, 
malted  milk,  weak  tea  ( no  sugar ) . 

AVOID. — -Champagne,  sweet  wines,  malt  liquors,  cider,  coffee, 
tobacco,  dried  fruits,  nuts,  cheese,  sweets,  pastry,  pies,  spices,  rich 
puddings,  fried  dishes,  vinegar,  pickles,  lemons,  rhubarb,  mush- 
rooms, asparagus,  sweet  potatoes,  tomatoes,  gravies,  patties,  rich 
soup,  eggs,  lobster,  salmon,  crabs,  mackerel,  eel,  veal,  pork,  goose, 
duck,  turkey;  salted,  dried,  potted  or  preserved  fish  or  meat  (except 
fat  bacon). 

ACUTE  RHEUMATISM 

Thompson  i 

Dietetic  Treatment.    While  the  fever  lasts  and  other  symp- 

iW.  Oilman  Thompson,  M.D. :  "Practical  Dietetics."  New  York.  D. 
Appieton  &  Co. 


DISORDERS  OF  NUTRITION  369 


toms  are  acute^  such  as  pain  and  swelling  of  the  joints,  the 
patient  should  be  put  upon  a  fluid  diet.  The  majority  of 
cases  do  best  at  this  time  with  an  exclusive  milk  or  bread- 
and-milk  diet.  Those  patients  who  cannot  take  milk,  how- 
ever, may  be  allowed  soups  and  broths  flavored  with  vegetable 
extracts,  chicken  tea,  milk  toast,  barley  or  oatmeal  gruel, 
clam  broth. 

Thirst  is  often  a  prominent  symptom,  especially  if  there 
be  much  fever,  and  it  is  advisable  for  the  patient  to  drink 
fluid  freely  to  assist  in  washing  out  the  waste  products  from 
the  body.  Lemonade  and  slightly  acid  drinks  of  various 
kinds,  such  as  dilute  phosphoric  acid  or  the  effervescent  min- 
eral waters,  are  recommended.  Boiled  milk  and  Seltzer  or 
Vichy  may  be  drunk,  or  oatmeal  or  barley  water  flavored 
with  lemon.  Alcohol  should  be  avoided  while  the  acute  symp- 
toms last,  unless  the  complication  of  inflammation  of  the 
endocardium  or  pericardium  enfeeble  the  heart  action,  if  pro- 
longed and  anaemia  is  considerable,  alcohol  may  be  given  as 
a  tonic  two  or  three  times  a  day  in  the  form  of  a  glass  of 
claret  or  Burgundy  (one  to  two  ounces),  or  diluted  whiskey. 

During  convalescence  the  appetite  is  not  usually  vigorous, 
and  it  is  not  necessary  to  urge  the  taking  of  much  food  at 
first.  The  diet  should  be  principally  farinaceous,  but  not 
saccharine. 

Such  articles  may  be  given  as  rice  (plain  or  spiced),  arrow- 
root, oatmeal,  cornmeal,  semolina,  wheaten  grits,  panada,  milk 
toast,  simple  unsweetened  puddings,  wine  jelly,  blanc-mange 
and  malted  foods. 

The  return  to  solid  diet  should  be  gradual,  and  for  a  long 
time  the  patient  should  abstain  from  eating  meats  as  well  as 
from  pastry  and  sweets.  Fagge  states  that  no  meat  or  fish 
should  be  allowed  for  at  least  a  week  after  subsidence  of  the 
fever  and  acute  symptoms,  or,  better,  for  a  fortnight,  and 
many  believe  that  beef  tea  is  harmful.  Meat  can  undoubtedly 
induce  a  relapse. 

When  convalescence  becomes  established,  eggs,  fish,  oysters, 
and  white  meat  of  broiled  or  roasted  chickens  may  be  given. 


370 


DIET  IN  DISEASE 


and  one  or  two  such  vegetables  as  asparagus^  spinach,  or 
stewed  celery,  with  a  baked  apple  or  fresh  fruit,  but  sweets 
and  alcohol  should  long  be  withheld. 

The  patient  should  be  fed  often,  having  one  or  two  extra 
lunches  during  the  day,  for  anaemia  is  apt  to  prevail  for  some 
time,  and  abundant  nutriment  is  required. 

RHEUMATISM 

Massachusetts  General  Hospital 

DIET. —  Graham  or  brown  bread,  white  bread  limited  ( %  slice 
daily),  corn,  granum,  rice,  milk,  eggs,  flour,  puddings,  crackers, 
beans,  peas,  all  kinds  of  vegetables  (except  potatoes  and  cooked 
tomatoes),  rhubarb,  fresh  fish;  butter,  cheese,  buttermilk,  cream, 
alkaline  waters,  toast. 

AVOID. —  Red  meats,  starch  or  potatoes,  white  bread,  sugars. 

CHRONIC  RHEUMATISM 

DIET:  Soup. —  Beef  tea,  chicken  and  mutton  broth  in  small 
quantities. 

Fish. —  Raw  oysters  or  clams,  white  fleshed  fresh  fish  —  broiled  or 
boiled. 

Meat. —  Sweetbreads,  chicken,  tripe,  broiled  fat  bacon  or  boiled 
ham  (all  sparingly). 

Farinaceous. —  Boston  brown  bread,  corn,  whole  wheat  bread, 
cornstarch,  rice,  milk  toast,  dry  toast,  graham  bread,  granum,  butter, 
crackers. 

Vegetables. —  All  except  potatoes  and  cooked  tomatoes. 

Desserts. —  Plain  puddings,  rhubarb;  junket  (all  without  sugar). 

Liquids. —  Milk,  cream,  buttermilk,  malted  milk,  alkaline  waters, 
tea,  cocoa  (no  sugar),  pure  water,  plain  or  with  lemon  or  lime  (no 
sugar) . 

AVOID. —  Red  meats,  pork,  turkey,  goose,  duck,  veal,  fried  fish, 
cooked  oysters  or  clams,  salted,  dried,  potted  or  preserved  fish  or 
meats  (except  ham  and  bacon).  Lobsters,  crabs,  salmon,  eggs,  rich 
pies,  made  dishes,  gravies,  potatoes,  tomatoes,  asparagus,  mushrooms, 
rich  puddings,  candies,  nuts,  cheese,  coffee,  cider,  malt  liquors,  wines. 

DIET  IN  OBESITY 

This  is  one  of  the  most  important  features  of  dietetic 
therapy^  and  is  older  and  better  known  than  any  other,  prob- 
ably because  of  its  connection  with  conditioning  athletes  for 


1  Diet  used  at  the  Massachusetts  General  Hospital,  Boston. 


DISORDERS  OF  NUTRITION  371 


all  kinds  of  contests  and  also  from  the  cosmetic  point  of 
view,  as  superfluous  flesh  generally  implies  advanced  years. 
Unlike  many  other  plans  of  diet  it  concerns  the  nominally 
healthy  rather  than  the  sick  and  invalid. 

The  old  trainer  of  athletes  knew  little  or  nothing  of  any 
scientific  regimen  for  reducing  adipose  tissue.  For  him  re- 
duction of  weight  was  merely  a  matter  of  getting  rid  of 
superfluous  water,  to  be  accomplished  by  sweating,  purgation 
and  abstinence  from  fluids.  He  rejected  certain  articles  of 
diet  as  "bad  for  the  wind/^  but  this  is  as  near  as  he  came 
to  specializing  in  diet.  Exercise,  without  profuse  perspira- 
tion, meant  nothing  to  him.  The  steady  grind  of  a  worker 
who  burns  up  so  much  excess  fat  daily,  yet  without  any  un- 
usual degree  of  perspiration,  is  something  he  took  no  account 
of. 

Of  recent  years  it  has  been  learned  that  abstinence,  hot 
baths  and  purgation,  are  far  less  efficaciotis  in  keeping  down 
weight  than  continuous  and  vigorous  exercise  within  the  fa- 
tigue limit.  It  is  much  less  a  matter  of  starvation  and 
elimination  than  of  a  steady  oxidation  of  superfluous  tissue 
by  graded  and  varied  exercises  extending  throughout  the  day. 
But  while  constant  exercise  is  the  chief  essential,  it  is  also 
important  to  curb  the  appetite  for  food  and  drink,  and  to 
keep  the  excretory  organs  active.  Otherwise,  in  the  case  of 
novices  at  least,  increased  exercise  will  provoke  increased 
appetite  for  food  and  drink,  so  that  not  a  few  people  gain 
flesh  while  trying  to  lose  it. 

Doubtless  the  best  plan  for  reducing  flesh  without  suffering 
and  violence  is  to  do  a  great  amount  of  work  daily,  severe 
ejiough  in  character  to  oxidize  much  body  fat,  but  without 
profuse  waste  of  fluids  by  sweating,  etc.  In  regard  to  the 
meals,  these  should  be  small,  light  and  as  frequent  as  desired. 
Nothing  should  be  taken  to  provoke  thirst.  Any  food-article 
whatever  which  is  especially  rich  in  starch,  sugar  or  fat,  along 
with  alcoholics,  must  be  omitted.  Such  individuals  thrive 
best  on  toast  or  biscuit  without  butter;  lean  meats,  fish  and 
eggs;  and  vegetables  which  grow  above  ground. 


372 


DIET  IN  DISEASE 


The  selection  of  food  differs  but  little  from  the  diabetic 
regimen^  but  some  carbohydrates  are  allowed,  while  the  fatty 
articles,  including  milk,  permissible  in  diabetes,  are  to  be 
avoided.  The  patient  is  not  to  be  stinted  in  quantity  pro- 
vided he  takes  the  necessary  amount  of  exercise.  He  may 
breakfast  freely  on  eggs,  meat  and  toast,  dine  on  meats  and 
salad  vegetables,  etc.  He  should  take  as  little  fluid  as  pos- 
sible with  his  meals,  but  may  quench  his  thirst  between  meals. 
By  masticating  his  food  thoroughly  he  materially  reduces  the 
demand,  and  does  away  with  eating  for  the  mere  sake  of  eat- 
ing. 

By  simple  measures  of  this  sort  an  individual  may  reduce 
his  weight  to  as  great  degree  as  desirable,  and  the  process 
will  not  be  painful  but  the  reverse.  He  simply  oxidizes  and 
otherwise  utilizes  a  little  more  matter  than  he  takes  in,  and 
thereby  prevents  a  pathological  and  unsafe  accumulation  of 
fat. 

DIET:  Fish.— All  fresh  white  fish  broiled  or  boiled. 

Meats. —  Lean  mutton  or  lamb,  beef,  chicken,  game  (sparingly). 

Eggs. —  Cooked  in  all  ways  ( not  fried ) . 

Farinaceous. —  Dry  toast  or  crusts,  stale  bread  (sparingly). 

Vegetables. —  Lettuce,  celery,  spinach,  cresses,  asparagus,  cauli- 
flowers, white  cabbage,  onions,  tomatoes,  radishes,  olives. 

Liquids. —  Coffee  or  tea,  one  cup  without  milk,  cream  or  sugar; 
pure  water  one  glass,  drank  slowly  after  the  meal. 

AVOID. —  Dark  flesh  fish,  rich  soups,  salt  fish,  veal,  pork,  sausage, 
fats,  potatoes,  oatmeal,  hominy,  macaroni,  spices,  rice,  carrots,  beets, 
turnips,  parsnips,  puddings,  pastry,  pies,  sugar,  sweets,  cakes, 
cream,  milk,  spirituous  liquors,  beers,  sweet  rums,  champagne. 


CHAPTEE  XVI 


DIET  IN  DISEASES  OF  THE  STOMACH 

ACUTE  GASTRITIS 

Einhorn  i 

During  the  first  or  second  day  of  illness  it  is  best  not  to 
give  the  patient  anything  substantial  to  eat.  Strained  barley 
or  rice  water,  or  weak  tea  may  be  taken.  On  the  third  day, 
as  soon  as  the  appetite  reappears,  the  patient  is  permitted  to 
partake  of  water  soup  (bread  and  hot  water)  oatmeal  or  bar- 
ley gruel,  rice  soup,  and  perhaps  one  soft-cooked  egg.  Later 
on  French  bread,  butter  and  oysters  may  be  added  to  the 
dietary. 

If  the  improvement  is  steadily  progressing  the  fourth  day 
begin  with  meat  once  a  day,  and  thus  slowly  return  to  the 
usual  bill  of  fare. 

CHRONIC  GASTRITIS 
Einhorn  i 

The  regulation  of  the  diet  is  of  prime  importance  in  the 
treatment.  The  dietary  to  be  selected  will  depend  on  the 
severity  of  the  symptoms. 

At  the  beginning,  therefore,  a  light  diet  will  be  called 
for.  The  patient  should  partake  of  four  meals  daily.  The 
articles  of  food  should  be  given  largely  in  liquid  and  semi- 
liquid  forms ;  that  is,  milk,  kumyss,  matzoon,  barley,  oat- 
meal, and  rice  soup  prepared  in  milk;  chicken  soup  with  an 
egg  beaten  up  in  it ;  soft-cooked  eggs,  mashed  potatoes,  scraped 
meat,  raw,  or  boiled,  toasted  bread,  and  also  French  white 
bread  (not  too  fresh) ;  butter;  tea  and  cocoa. 

1  Max  Einhorn,  M.D. :  "Disease  of  the  Stomach."  New  York.  Wil- 
liam Wood  &  Co. 

373 


374 


DIET  IN  DISEASE 


The  quantity  of  nourishment  for  each  meal  should  neither 
be  excessively  large  nor  too  small. 

My  own  bill  of  fare  for  the  first  week  of  the  treatment  is  as 
follows : 


Eight  o'clock:  .  Calories. 

Two  eggs   160 

TW  ounces  of  French  white  bread   156 

One-half  ounce  of  butter   107 

One  cup  of  tea  (100  gm.  of  tea,  .150  gra.  milk)   101 

Sugar  10  gm.  (3  iiss.)   40 

Half  past  ten  o'clock: 

Kumyss  or  matzoon  or  milk,  250  gm.  (3  viii.  1/3)   168 

Crackers,  30  gm.   (one  ounce)   107 

Butter,  20  gm.  (5  v.)   163 

Half  past  twelve  o'clock: 

Two  ounces  of  tenderloin  steak,  or  of  white  meat  of  chicken.  76 

Mashed  potatoes,  or  thick  rice,  100  gm.  (J  iii.  1/3)   127 

White  bread,  two  ounces   153 

Butter,  one-half  ounce   107 

One  cup  of  cocoa,  200  gm.  (3  vi.  %)   101 

Half  past  three  o'clock: 

The  same  as  half  past  ten   438 

Half  past  six  o'clock: 

Farina,  hominy,  or  rice  boiled  in  milk,  one  plateful,  250  gm. 

(3  viii.  1/3)   440 

Two  scrambled  eggs   160 

Bread,  two  ounces   156 

Butter,  one-half  ounce   107 


2.863 

The  patient  having  been  kept  on  this  diet  for  a  week  or 
two^  the  diet  must  be  gradually  changed  to  one  suitable  for 
the  lighter  forms  of  chronic  gastritis.  Here  the  following 
rule  will  apply:  The  diet  should  correspond  as  nearly  as 
possible  to  the  common  mode  of  living.  In  this  way  the  dis- 
tribution of  the  meals  should  be  arranged  according  to  the 
customs  prevailing  in  those  places  in  which  the  patient  lives. 

All  food  derived  from  the  vegetable  kingdom  should  be 
given  in  large  portions,  while  the  quantity  of  meat  should  be 
somewhat  limited. 


DISEASES  OF  THE  STOMACH  375 


In  order  to  permit  the  patient  to  have  a  greater  variety 
in  his  food,  it  is  best  not  to  point  out  a  few  articles  he 
should  eat,  but  to  mention  only  those  he  should  avoid.  For- 
bid meat  with  very  tough  fibers,  meat  from  too  old  animals 
or  too  fresh  meat  (right  after  slaughtering)^  meat  that  con- 
tains too  much  fat,  like  pork;  forbid  sausages,  lobster,  sal- 
mon, chicken  salad,  mayonnaise,  cucumbers,  pickles,  cabbage, 
strong  alcoholic  drinks  like  liquors. 

It  must  be  impressed  upon  the  patient  to  masticate  the 
food  thoroughly,  to  eat  slowly,  not  to  think  of  business  dur- 
ing meals,  and  to  stop  eating  before  the  sensation  of  satiety 
appears.  The  latter  advice  is  only  necessary  in  persons  who 
are  accustomed  to  high  living. 

Chronic  gastric  catarrh  is  frequently  combined  with  con- 
stipation. The  diet  can  be  arranged  as  to  facilitate  move- 
ment of  the  bowels.  All  foods  Avhich  contain  a  large  per- 
centage of  cellulose  (undigested  matter)  increase  the  quantity 
of  feces,  thereby  effecting  a  stronger  peristalsis  of  the  larger 
bowel. 

All  kind  of  green  vegetables  (spinach,  asparagus,  green 
peas)  and  rye  bread  are  therefore  very  suitable.  Many  or- 
ganic acids  possess  the  property  of  increasing  intestinal  peri- 
stalsis. Almost  all  kinds  of  fruits  contain  a  certain  quantity 
of  these  organic  acids,  and  act  like  mild  aperients.  The  use 
of  cooked  pears,  stewed  or  baked  apples,  stewed  prunes,  is  in 
many  instances  effective.  Ewald  recommends  a  mixture  of 
two  parts  of  prunes  to  one  part  of  dried  figs.  The  taste  is 
agreeable,  and  the  cathartic  action  mild.  The  custom  of 
eating  an  orange  in  the  morning  for  its  laxative  effect  is  well 
known.  To  these  dietary  remedies  we  may  also  add  the  use 
of  a  glassful  of  either  very  cold  or  warm  water,  or  a  glass  of 
milk  in  arising,  in  the  fasting  condition. 

THere  are  many  persons  in  whom  one  of  these  latter  means 
produces  a  good  movement  of  the  bowels. 


376 


DIET  IN  DISEASE 


TJLCER  OF  THE  STOMACH 

Einhorn  i 


The  diet  consists  of  liquids  —  milk,  milk  with  strained 
barley,  or  oatmeal,  or  rice  water;  plain  water,  weak  tea  and 
peptone  (one  teaspoon  to  a  cup  of  water).  Debove  and 
Eemond  have  suggested  the  addition  of  lactose  and  of  meat 
powder  to  the  milk,  in  order  to  make  the  diet  richer  in 
nourishment  substances. 

As  a  rule,  we  employ  the  above-named  additions,  which 
fulfill  the  same  purposes,  besides  varying  the  monotonous  bill 
of  fare. 

First  week.  During  the  first  week  we  give  the  patient  half 
a  cup  (about  100-150  c.c.)  of  either,  every  hour.  Every- 
thing the  patient  takes  must  be  neither  cold  or  very  warm, 
and  should  be  taken  slowly  (sipping,  or  with  a  spoon). 

Second  week.  During  the  second  week  we  order  the  same 
kind  of  food,  with  this  difference,  that  he  is  nourished  every 
two  hours,  and  gets  a  cupful  or  a  cupful  and  a  half  (200  to 
300  c.c.)  at  a  time. 

Occasionally  we  now  allow  the  patient  one  raw  egg  beaten 
up  in  the  milk,  once  or  twice  a  day.  In  the  beginning  of  the 
third  week  we  feed  the  patient  every  three  hours;  he  is  al- 
lowed barley,  farina,  and  rice  (well  cooked)  in  milk,  soft- 
cooked  eggs,  crackers  softened  in  milk,  in  addition  to  his 
previous  foods;  in  the  third  day  of  the  third  week  we  begin 
to  give  the  patient  meat,  first  raw,  well  scraped,  then  broiled. 

Thereafter  we  go  over  to  the  ordinary  daily  diet,  exclud- 
ing heavy  salads,  pastry,  raw  fruit  and  the  like. 

In  the  following  table  I  give  an  outline  of  diet  which  I 
ordinarily  prescribe  in  this  affection : 


OUTLINE  OF  DIET  IN  GASTRIC  TLCER 

First  Three  Days 


7  A.M.:  milk,  150  C.C.  (five  ounces) 

8  "      milk,  150  C.C.  (five  ounces) 


Number  of 
Calories. 

  101 

  101 


^  Max  Einhorn,  M.D. :  "Disease  of  the  Stomach."  New  York.  Wil- 
liam Wood  &  Co. 


DISEASES  OF  THE  STOMACH  377 

9  A.M.:  milk,  150  C.C.  (five  ounces)   101 

10  "      milk  and  strained  barley  water  (aa,  150  C.C.)  ....  80 

11  "      milk,  150  C.C...   101 

12  "      milk,  150  C.C   101 

1  p.  M. :  bouillon  either  alone  or  with  the  addition  of  one  to 

two  teaspoonfuls  of  a  peptone  preparation,  150 

C.C    30 

2  "      milk   101 

3  "      milk    101 

4  "      milk   101 

5  "      milk  with  strained  barley  or  oatmeal   80 

6,  7,  8,  9  P.  M.:  milk,  150  C.C   404 


1.402 

Fourth  to  the  Tenth  Day 

Number 
of  Calories. 

7  A.M.:  milk,  300  C.C.  (ten  ounces)   202 

9  milk,  300  C.C.  (ten  ounces)   202 

11  "  milk  with  barley,  rice,  or  oatmeal  water,  300  C.C. .  160 
1  p.  M. :  one  cup  of  bouillon,  200  C.C,  and  one  egg  beaten 

up  in  it   .  80 

3     "      milk,  300  C.C   202 

5     "      milk,  300  C.C   202 

7  milk  with  barley  water,  300  C.C   160 

9     "      milk,  300  C.C   202 


1.410 

Eleventh  to  the  Fourteenth  Day 

Number  of 
Calories. 

7  A.M.:  milk,  300  C.C   202 

9     "      milk,  300  C.C   202 

and  two  crackers  softened  (one  ounce)   100 

11     "      milk  with  barley  water,  300  C.C    160 

1  p.  M. :  one  cup  of  bouillon,  200  C.C,  one  egg,  and  two 

crackers    180 

3     "      milk,  300  C.C,  and  one  egg   282 

5     "      milk,  300  C.C,    202 

and  two  crackers   100 

7     "      milk,  with  barley  water   160 

9     "      milk,  300  C.C   202 


1.790 


378 


DIET  IN  DISEASE 


Fourteenth  to  the  Seventeenth  Day 

Number  of 
Calories. 

7am.:  milk,  300  C.C   202 

9     "      milk,  300  C.C   202 

and  two  crackers  (one  ounce)   100 

11     "      milk  with  barley,  300  C.C   342 

1  P.  M. :  scraped  meat,  50  gm   60 

two  crackers,  one  cup  of  bouillon,  200  C.C   100 

5  "      milk,  300  C.C   202 

6  "      milk,  300  C.C   202 

one  egg  (soft  boiled)   80 

two  crackers    100 

7  "      milk  with  farina,  300  C.C   342 

9    "      milk,  300  C.C   202 


2.134 

Seventeenth  to  Twenty-Fourth  Day 

Number  of 
Calories. 

7  A.  M.:  two  eggs  (soft  boiled)    160 

butter,  10  gm   81 

toasted  bread,  50  gm   130 

milk,  300  C.C   202 

10    "      milk,  300  C.C   202 

crackers,  50  gm   166 

butter,  20  gm   162 

1  P.  M  :  lamb  chops  (broiled),  50  C.C   60 

mashed  potatoes,  50  gm   44 

toasted  bread,  50  gm   130 

butter,  10  gm. ;  one  cup  of  bouillon,  200  C.C   81 

4    "      the  same  as  at  10  a.  m   530 

6:30     "      milk  with  farina,  300  C.C   342 

crackers,  50  gm   166 

butter,  20  gm.   162 

9     "      milk,  300  C.C   202 


2.820 

In  cases  of  ulcer  of  the  stomach  presenting  a  more  severe 
type  —  violent  pains,  frequent  vomiting,  inability  to  take 
food  on  account  of  the  pains  —  or  after  hsematemesis,  I 
usually  have  the  patient  abstain  from  any  food  whatever, 


DISEASES  OF  THE  STOMACH  379 


given  by  the  mouth,  for  a  period  of  five  days.  The  patient 
is  then  fed  by  the  rectum.  This  is  done  in  the  following  way : 
early  each  morning  the  patient  receives  a  large  enema  of 
about  a  quart  of  lukewarm  water,  in  which  a  teaspoonful  of 
common  tablesalt  has  been  dissolved  as  a  cleansing  enema. 
About  an  hour  after  the  patient  has  emptied  the  injected 
M^ater,  the  first  nourishing  enema  is  given;  this  may  consist 
either  of  a  glassful  of  milk  (about  200  c.c),  in  which  a  raw 
egg  has  been  well  beaten  and  a  pinch  of  salt  added,  or  of  a 
cupful  of  water  in  which  a  tablespoon  of  a  good  peptone 
preparation  has  been  dissolved.  The  temperature  of  either 
must  be  about  100°  F.  Such  a  nourishing  enema  is  given 
three  or  four  times  a  day.  The  quantity  of  the  feeding  enema 
is  200-250  c.c,  and  it  is  slowly  injected  by  means  of  a  foun- 
tain syringe  and  a  soft-rubber  rectal  tube.  The  patient  may 
frequently  wash  his  mouth  with  cold  water,  and  is  allowed 
from  time  to  time  to  keep  a  small  piece  of  chopped  ice  in 
his  mouth,  and  to  swallow  the  melted  water.  The  five  days 
being  over,  the  mode  of  diet  is  the  same  as  described  above 
for  the  ordinary  form  of  ulcer. 

GASTRIC  ULCER  DIET 
Massachusetts  General  Hospital  i 

1.  Dr.  Hewes's  Diet  for  Gastric  and  Duodenal  Ulcer.  Two 
oz.  milk,  1  soda  cracker  (powdered),  1  oz.  sugar,  every  two 
hours.  Give  two  to  three  days,  then  increase  to  6-8  oz.  milk, 
1-2  oz.  sugar,  4  soda  crackers,  every  two  hours.  Continue 
for  two  to  three  weeks,  then  adopt  the  following :  Eight  feed- 
ings in  24  hrs. :  (1)  milk  and  crackers;  (2)  Indian  meal 
porridge  with  cream  or  salt;  (3)  potato  puree,  jelly;  (4) 
milk  and  whites  of  two  eggs;  (5)  soft  custard;  (6)  hot  choco- 
late; (7)  pea  puree  strained  through  fine  wire  mesh;  (8) 
milk  and  crackers. 

2.  "The  Lenhartz  Diet.''  The  "Lenhartz  diet''  begins 
with  100  c.c.  milk  and  one  egg  daily,  in  teaspoonful  doses, 

^Diet  used  at  the  Massachusetts  General  Hospital,  Boston. 

Dr.  Hewes,  Physician  to  Out-Patients,  Massachusetts  General  Hospital. 


380 


DIET  IN  DISEASE 


gradually  increasing  until  at  the  end  of  four  weeks  a  liberal 
mixed  diet  is  allowed,  always  avoiding  coarse  vegetables  and 
irritating  substances. 

The  gradual  increase  of  food  appears  in  the  accompanying 
scale. 

In  preparing  the  eggs  they  are  beaten  very  light,  without 
salt,  a  small  amount  of  sugar  frequently  added,  the  bowl  kept 
in  a  pan  of  cracked  ice.  At  first  the  milk  is  given  with 
shaved  ice.  Some  of  the  milk,  eggs,  and  sugar  are  made  into 
custard  on  the  tenth  day.  The  beef  is  scraped  and  weighed 
after  cooking;  the  ham  is  chopped  very  fine;  occasionally 
lime  water  has  to  be  added  to  the  milk,  and,  if  large  curds 
form,  the  milk  is  diluted  with  barley  water.  Great  care  is 
exercised  in  the  transition  stages  from  liquids  to  semi-solids 
and  finally  to  full  diet. 


Lenhartz'  Diet 


Day  1 

Eggs 

Milk 

1 

Sugar 

Meat 

Rice 

Zwieback 

1 

Ham  11 

Butter  " 

1 

1 

C.  C. 
200 
200 

Gms, 

Gms. 

Gms. 

Gms. 

Gms. 

Gms, 

2 

2 

3 

3 

300 

4 

4 

400 

20 
20 
30 

5 

5 

500 

6 

6 

600 

7 

7 

700 

30 

35 

8 

8 

800 

40 

70 

100 

9 

8 

900 

40 

70 

100 

20 

10 

8 

1000 

50 

70 

200 

40 

11 

8 

1000 

50 

70 

200 

40 

50 

20 

12 

8 

1000 

30 

70 

300 

60 

50 

40 

Continue  for  3  weeks 

CHAPTER  XVII 


DIET  IN  INTESTINAL  DISEASES 

DIET  IN  DYSPEPSIA 

Modern  clinical  medicine  does  not  recognize  such  a  dis- 
ease as  dyspepsia.  In  a  great  variety  of  local  and  general 
conditions  digestion  is  more  or  less  disordered.  It  may  be 
too  rapid^  too  slow,  difBcult,  imperfect  for  one  or  more  of 
the  classes  of  foods,  or  abolished  outright.  Specialists  base 
diets  largely  on  the  results  of  test-meals,  so  that  the  diet  in 
a  given  case  becomes  individualized.  If  a  person  with  ordi- 
nary symptoms  of  chronic  indigestion  is  to  be  dieted,  and 
the  cause  of  the  affection  is  not  known,  the  regimen  for 
chronic  gastritis  will  answer  (p.  373).  But  if  in  addition 
to  indigestion  there  is  unusual  irritability  of  the  stomach,  the 
diet  must  consist  of  most  easily  digested  articles  of  solid  food, 
and  if  necessary  of  semi-solid  or  liquid  food.  In  other  words^ 
he  is  dieted  like  a  convalescent  from  some  severe  acute  dis- 
ease, or  a  child  at  weaning  time. 

DIET:  Soup. —  Oysters  and  thin,  clear  beef  and  mutton  soup. 
Fish. —  Fresh  mackerel,  bass,  perch,  shad,  cod,  raw  oysters. 
Meats. —  Game,  sweetbreads,  tender  meats,  chopped  meats,  broiled 
calf's  head,  tongue,  tripe,  lamb,  chicken,  mutton  and  beef. 
Eggs. —  Eggs  raw,  soft  and  hard  cooked. 

Farinaceous. —  Graham  bread,  whole  wheat  bread,  corn  bread, 
stale  bread,  dry  toast,  crackers,  tapioca,  sago,  cornstarch,  rice,  oats, 
hominy,  cracked  wheat. 

Vegetables. —  Asparagus,  celery,  cresses,  lettuce,  green  peas,  string 
beans,  sweet  corn,  spinach. 

Desserts. —  Ripe  fruit  —  raw  or  stewed ;  apple  tapioca,  apple  snow, 
baked  apples,  custards,  junkets,  rice,  tapioca,  cornstarch,  or  bread 
puddings. 

Liquids. —  Liquid  Peptonoids  on  cracked  ice,  pure  cold  water,  hot 
water  and  milk  (equal  parts),  malted  milk,  weak  tea  and  coffee,  not 

381 


382 


DIET  IN  DISEASE 


more  than  one  cup  at  a  time  and  taken  slowly  after  a  meal;  un- 
fermented  grape  juice. 

AVOID. —  Ice  water,  spirituous  liquors,  nuts,  cheese,  ice  cream, 
pastry,  pies,  candies,  salmon,  lobster,  crabs,  sausages,  ducks,  goose, 
salted,  smoked  or  preserved  fish;  pickled,  potted,  corned  or  cured 
meats,  kidney,  liver,  fried  foods,  gravies,  potatoes,  turkey,  stews, 
hashes,  pork,  veal,  rich  soups,  chowder. 

DIET  IN  CONSTIPATION 

It  is  almost  as  difficult  to  prescribe  a  diet  for  constipation 
as  it  is  for  dyspepsia,  and,  for  the  same  reason,  namely,  con- 
stipation is  not  in  itself  a  disease,  but  a  symptom  or  result  of 
many  diseases.  As  a  general  rule,  however,  a  certain  diet  is 
more  or  less  suitable  for  any  kind  of  constipation.  By  the 
latter  term  we  usually  mean  a  delayed  action  of  the  bowels 
due  to  a  natural  weakness  of  the  muscles  of  the  intestines,  or 
to  an  acquired  weakness  due  to  too  concentrated  a  form  of 
nourishment  or  to  a  sedentary  life.  In  a  certain  percentage 
of  cases  the  delayed  action  of  the  bowels  is  due  to  temporary 
spasm  of  the  intestinal  muscle,  and  this  may  even  occur  in 
association  with  weakness  of  the  muscle,  as  is  seen  in  hysteri- 
cal women.  There  is  finally  delayed  bowel  action  in  a  great 
number  and  variety  of  diseases. 

The  resources  employed  in  treating  the  diseases  which 
cause  constipation  include  many  plans  beside  diet,  yet  the 
latter  is  indispensable. 

A  mixed  diet  is  very  necessary,  for  purely  animal  food 
products,  as  meat,  fish,  eggs,  milk,  cheese,  etc.,  conduce  to 
constipation  because  absorption  of  such  foods  is  so  nearly 
complete  that  not  enough  residue  remains  in  the  intestines  to 
stimulate  peristalsis.  On  the  other  hand,  a  diet  of  vegetables, 
involving  a  large  indigestible  residue,  causes  large  fecal  mo- 
tions, but  these  are  not  promptly  expelled  unless  the  intestine 
is  healthy.  Much  extra  work  is  thrown  upon  the  intestine 
when  a  vegetarian  diet  is  used  exclusively;  and  as  a  result 
of  such  excessive  work  the  intestine  becomes  in  time  weak- 
ened. 

Constipation  from  whatever  cause  and  of  whatever  nature 


INTESTINAL  DISEASES 


383 


may  be,  when  sufficiently  pronounced,  sufficient  to  render  a 
healthy  man  or  woman  sick.  Digestion  becomes  impaired, 
appetite  lost.  This  fact  alone  teaches  us  that  in  dieting  a 
constipated  subject  we  often  have  to  deal  with  a  sick  in- 
dividual. It  has  often  been  stated  that  a  patient  or,  his  life- 
long companions  are  better  judges  as  to  his  diet  than  a 
physician  hastily  consulted. 

Ewald,  and  doubtless  most  stomach  specialists,  are  opposed 
to  an  exclusive  calorie  plan  of  feeding  in  all  gastro-intestinal 
diseases.  This  is  natural  because  food  which  is  theoretically 
indicated  cannot  be  managed  by  the  digestive  organs.  If  an 
attempt  is  made  to  feed  a  patient  thus  affected  with  3000 
calories  of  food,  the  result  will  be  complete  repugnance  to 
all  food.  The  amount  of  food  ingested  in  these  cases,  in 
the  most  palatable  and  digestible  form,  cannot  come  up  to 
the  calorie  standard.  The  quantity  ingested  in  such  pa- 
tients is  so  low  as  to  be  quite  beneath  the  efficient  level.  The 
inference  is  natural  that  such  patients  must  draw  on  their 
reserve  fund  to  make  up  the  calories. 

Hence  the  only  course  to  pursue  is  to  cure  the  condition 
which  causes  the  constipation  as  soon  as  possible.  For  mere 
sluggish  action  of  the  bowels,  not  amounting  to  disease,  many 
popular  dietetic  remedies  are  employed.  It  is  by  no  means 
certain  that  this  delayed  action  in  many  healthy  persons  is 
other  than  natural  or  temperamental.  Fletcher  has  shown 
that  as  a  result  of  his  reduced  diet  and  excessive  mastication 
of  food  which  contains  not  much  indigestible  residue,  sterile 
and  odorless  feces  are  formed  which  cause  no  discomfort,  and 
insists  that  such  people  need  have  no  anxiety  about  their 
bowels.  On  the  other  hand,  very  many  people  who  have  reg- 
ular daily  evacuations  suffer  from  retention  of  fecal  matter  ; 
only  careful  palpation  of  the  sigmoid  flexure  will  inform  us 
as  to  whether  the  bowels  are  actually  empty. 

Of  household  dietetic  procedures  for  securing  daily  evacua- 
tions, the  most  common  is  the  drinking  of  cold  water  on  ris- 
ing —  one,  two  or  more  glasses.  To  this  a  little  common  salt 
may  be  added.    Many  men  depend  for  their  morning  evacua- 


384 


DIET  IN  DISEASE 


tion  on  smoking  a  cigar  after  breakfast.  Women,  as  already 
stated,  find  the  morning  draught  of  cold  water  valuable. 
The  use  of  fruit  at  or  before  breakfast  often  causes  an  evacua- 
tion during  the  day.  This  is  true  especially  of  apples,  pears, 
oranges,  etc.  Buttermilk  is  also  largely  used  for  this  purpose. 
The  vegetable  acids  with  the  large  amount  of  indigestible 
residue  make  certain  fruits  valuable  as  laxatives.  This  is 
true  also  of  berries,  although  those  which  contain  tannin 
(blackberries)  may  tend  to  constipate.  Dried  fruits,  such  as 
figs  and  prunes  are  especially  useful.  The  use  of  sweet  cider 
as  a  marked  laxative  seems  to  illustrate  again  the  laxative 
power  of  vegetable  acids.  Very  sweet  substances  in  large 
amounts,  chiefly  honey  and  molasses  are  notably  laxative. 
Oatmeal,  among  the  cereal  foods,  is  noted  for  its  laxative 
powers.  Beans  and  peas,  popularly  believed  to  be  laxative, 
are  really  constipating;  but  the  fermentation  of  the  large 
amount  of  cellulose  gives  the  illusion  of  impending  diarrhoea. 
Oils  and  fats  are  laxative  to  many  people.  A  word  of  cau- 
tion must  here  be  inserted.  Many  of  these  substances  care- 
lessly spoken  of  as  laxatives,  often  behave  as  violent  purga- 
tives, especially  in  individuals  who  alternate  between  consti- 
pation and  diarrhoea.  The  severe  diarrhoea  set  up  at  times 
by  sweet  cider,  molasses  and  other  relatively  inert  sub- 
stances should  teach  us  caution  in  giving  such  articles  to 
patients. 

No  more  important  hygienic  regimen  can  be  adopted  than  the  fol- 
lowing: 1.  Eat  fruit  before  retiring  (experiment  and  find  what 
fruit  seems  to  agree).  2.  Three-quarters  of  an  hour  before  breakfast 
drink  two  glasses  of  cold  water  and  exercise  ten  minutes  in  room 
before  open  window  or  take  a  brisk  walk.  If  this  regimen  were 
followed  daily  by  children  and  grown  people  there  would  be  less 
illness. 

DIET:  Soup, —  Oyster  soup,  meat  broths. 

Fish. —  Raw  oysters,  fresh  fish  of  all  kinds  broiled  or  boiled. 

Meats. —  Game,  poultry,  almost  any  fresh  meats. 

Farinaceous. —  Rye  bread,  brown  bread,  graham,  corn  and  whole 
wheat  bread,  hominy,  mush,  cereals,  Bran  Cookies,  breakfast  food 
containing  flaxseed. 

Vegetables. —  Salads  with  oil,  string  beans,  green  peas,  green  corn. 


INTESTINAL  DISEASES 


385 


asparagus,  potatoes,  cauliflower,  spinach,  brussels  sprouts,  onions, 
boiled. 

Desserts. — ■  Simple  and  light-apple  and  fig  puddings,  plain  pud- 
ding, as  custards,  whips,  and  gelatin,  etc.,  junkets,  ice  cream,  sherbet, 
ices,  hominy,  raisins,  cherries,  huckleberries  (the  blue  seedless  kind), 
grapes,  melons,  apples,  oranges,  pears,  ripe  peaches,  baked  apples, 
with  cream,  figs,  stewed  prunes. 

Liquid. —  Unfermented  grape  juice,  plenty  of  pure  water,  cold  or 
hot;  black  coffee,  cocoa,  new  cider,  buttermilk,  orange  juice,  malted 
milk. 

AVOID. —  Spirituous  liquors,  pineapple,  cheese,  nuts,  tea,  sweets, 
milk,  pastry,  rich  puddings,  rice,  tapioca,  new  bread,  eggs,  liver, 
pork,  salt,  smoked,  potted  or  preserved  fish  or  meats. 

DIET  IN  DIARRHOEA 

The  term  diarrhoea^  like  dyspepsia  and  constipation^  repre- 
sents only  a  symptom  or  result  of  various  diseases.  While 
this  affection  cannot  be  cured  by  a  dietetic  plan  alone^  certain 
foods  are  known  to  be  constipating  and  in  treating  the  under- 
lying conditions  attention  to  diet  is  all-important.  It  con- 
sists as  much  in  avoiding  laxative  articles  as  in  using  consti- 
pating articles.  Thus  cheese  and  hard-boiled  eggs  are  highly 
constipating  to  most  individuals^  yet  they  could  not  be  em- 
ployed in  a  diarrhoea  which  was  due  to  or  associated  with 
gastritis.  Hence  foods  known  to  be  constipating  must  also 
be  bland  and  easily  digested.  Food  nearly  all  of  which  may 
be  absorbed  naturally  antagonizes  diarrhoea  from  any  cause. 
The  commonest  articles  used  in  this  class  are  flour  porridge, 
cooked  white  of  eggs,  boiled  milk,  toasted  crackers,  zwieback, 
rice,  chocolate.  Meat  should  be  of  the  most  tender  and  diges- 
tible nature,  as  sweetbreads,  tongue,  tenderloin  of  beef,  etc. 
Dried  beef  powder  may  be  mixed  with  5  per  cent,  tannic  acid. 
Articles  which  naturally  contain  the  latter  are  useful  if  di- 
gestible.   Acorn  coffee  is  recommended  by  some. 

In  a  daily  menu  compiled  by  Ewald  the  following  articles 
enter:  Soft  eggs,  milk,  toasted  bread,  zwieback,  scraped 
beef,  breast  of  chicken,  the  most  digestible  kinds  of  fish, 
soups  and  broths  (to  the  latter  may  be  added  Dry  Pepto- 
noids  Soluble,  Sanatogen  and  other  semi-proprietary  condensed 


386 


DIET  IN  DISEASE 


protein  foods).  Articles  used  in  diet  list  for  constipation 
must  be  avoided. 

Massachusetts  General  Hospital  i 
DIET. —  Stale  bread,  dry  toast,  crackers,  butter,  rice,  soft  cooked 
eggs,  eggs  and  milk,  flour  and  milk  puddings,  boiled  and  peptonised 
milk,  tea,  custards,  blanc-mange,  wine  jelly,  oatmeal,  oysters,  gruel, 
chicken. 

AVOID. —  Soups,-  animal  broths,  fresh  bread,  fruits,  vegetables^ 
fried  dishes,  fish,  saccharine  foods,  salt  meats,  veal,  lamb  and  pork. 

DYSENTERY 
Thompson  2 

During  an  attack  of  acute  dysentery  the  patient  should  be 
kept  absolutely  quiet  in  bed^  and  should  not  be  allowed  to 
rise  for  the  movement  of  the  bowels^  making  use  of  a  bed- 
pan instead.  Throughout  the  active  stage  the  diet  must  be 
strictly  confined  to  easily  digestible  food,  and  in  most  cases  it 
is  wisest  to  give  only  predigested  fluid  articles.  Peptonised 
or  pancreatinized  milk,  or  boiled  milk,  pressed-meat  juice, 
whey,  or  raw  egg  albumin  beaten  with  sherry  and  flavored 
with  nutmeg  are  recommended.  Many  patients  do  best  upon 
a  diet  of  raw  scraped  beef  or  meat  balls. 

In  cases  of  acute  dysentery,  and  especially  in  the  amoebic 
form,  the  loss  of  strength,  anaemia,  and  emaciation  progress 
very  rapidly,  and  the  strength  must  be  supported  by  stimula- 
tion, for  which  brandy  is  preferable  to  whiskey. 

During  convalescence  the  diet  must  be  very  cautiously  in- 
creased, and  confined  to  food  which  is  promptly  and  com- 
pletely digested,  leaving  but  little  residue.  For  this  purpose 
animal  food  should  be  chiefly  eaten,  while  fish,  tender  beef- 
steak, roast  beef,  boiled  or  broiled  chicken,  eggs,  custard, 
blanc-mange,  dry  toast,  junket,  well-boiled  rice,  or  wine  jelly, 
may  be  given.  All  fruits  and  vegetables  must  be  forbidden, 
and  butter  and  cream  should  be  taken  sparingly. 

If  the  disease  occurs  in  infancy,  the  child,  if  possible, 
should  be  fed  at  the  breast.    Otherwise  all  milk  and  water 

1  Diet  used  at  the  Massachusetts  General  Hc^spital,  Boston. 

2  W.  Gilman  Thompson,  M.D. :  "Practical  Dietetics."  New  York.  D. 
Appleton  &  Co. 


INTESTINAL  DISEASES 


387 


given  should  be  Pasteurized.  Beef  tea  and  mutton  broth 
may  be  allowed  in  moderation^  and  special  care  should  be 
observed  not  to  overfeed. 

DIET  FOR  ACUTE  COLITIS  (DYSENTERY) 

Massachusetts  General  Hospital  i 

Purge  and  starve  one  day,  then:  lean  meat,  100  gms.,  3 
times  daily ;  albumin  water  of  2  eggs,  6-8  times  daily.  Con- 
tinue for  4  days,  then  add:  skimmed  milk,  16  oz. ;  toast  (no 
butter),  3  slices  with  maple  syrup;  rice,  50  gms.  daily.  After 

10  days  increase  toast,  give  butter,  macaroni,  tapioca,  cream 
cheese  and  Indian  meal  mush. 

CHRONIC  DYSENTERY 

Thompson  2 

Chronic  dysentery  is  often  best  treated  by  an  exclusive 
milk  diet  of  from  two  and  a  half  to  three  quarts  a  day,  with 
rest  in  bed  or  on  the  lounge.  In  other  cases  rare  steak  or 
roast  beef  or  chicken  and  egg  albumin  may  be  allowed,  with 
dry  toast,  zwieback,  or  crackers.  The  milk  and  meat  diet 
may  be  advantageously  combined. 

In  Osier's  opinion,  if  there  is  much  ulceration  of  the  colon, 
meat  is  not  well  borne,  and  it  is  better  to  keep  the  patient 
upon  a  diet  which  will  give  but  little  residue,  such  as  boiled 
or  peptonised  milk. 

The  stools  must  be  examined  every  day  or  two  to  ascertain 
the  presence  of  undigested  fra^ents  of  milk  curds  or  meats,, 

011  globules,  mucus,  blood,  etc.  If  improvement  does  not 
occur,  the  patient  may  be  put  upon  a  diet  of  egg  albumin  or 
Sanatogen  with  beef  juice,  or  some  of  the  preparations  of  beef 
meal  or  peptonoids,  with  pancreatinised  milk.  Eeturn  to 
solid  diet  must  be  very  gradual,  and  may  be  conducted  on 
the  lines  directed  for  convalescence  from  typhoid  fever. 

^Diet  used  at  the  Massachusetts  General  Hospital,  Boston. 
2W.  Gilman  Thompson,  M.D. :     "Practical  Dietetics."    New  York.  D. 
Appletou  &  Co. 


388 


DIET  IN  DISEASE 


ENTERIC  DIET 
Dr.  Vickery  i 

Milk,  strained  gruels,  broths  and  strained  soups,  milk  whey, 
buttermilk,  slips,  eggs  (soft  cooked  or  raw),  milk  flavored  occa- 
sionally with  tea  or  coffee,  barley  water,  albumin  water,  beef  juice. 


SPECIAL  ENTERIC  DIET 


cutler  ^ 

Skimmed  Milk 

8  oz. 

at  7 

A.M. 

Mellins'  Food 

.  8  " 

"  9 

(6 

Skimmed  Milk 

8  "  . 

"  11 

(C 

Eggs  and  Milk 

8  "  ^ 

"  1 

P.M. 

Beef  juice 

3  "  with 

Barley  water 

3  " 

"  3 

ss 

Skimmed  Milk 

6  "  with 

Tea 

i  " 

"  5 

(( 

Chicken  Broth 

4  "  with 

Barley  Water 

3  " 

(< 

i 

<e 

Buttermilk 

8  " 

"  9 

a 

Skimmed  Milk 

8  " 

"  11 

a 

Beef  Tea 

8  " 

"  1 

A.M 

Skimmed  Milk 

8  " 

"  3 

Albumin  Water 

8  " 

"  5 

LIQUID  ENTERIC  DIET 


Cutler  2 

Skimmed  Milk 

8 

oz 

4 

times 

every  24  hours 

Skimmed  Milk 

6 

with 

Tea  or  Coffee 

2 

Beef  Tea 

8 

1 

<{ 

i(  e( 

Chicken  broth 

3 

with 

Barley  Water 

3 

1 

(( 

((  <( 

Mellins'  Food 

8 

(( 

1 

(( 

((  <( 

Albumin  Water 

8 

(( 

1 

(( 

i(  (( 

Beef  juice 

3 

(< 

with 

Barley  Water 

3 

i( 

1 

((  (( 

Buttermilk 

8 

(( 

1 

it  (( 

One  soft  boiled  egg  daily  if  desired  or  raw  in  milk. 


1  Dr.  Yickery:  "Diet  used  at  the  Massachusetts  General  Hospital,  Bos- 
ton." 

2  Elbridge  G.  Cutler,  M.D. :  *  *  Diet  used  at  the  Massachusetts  General 
Hospital,  Boston." 


INTESTINAL  DISEASES 


389 


APPENDICITIS 

Thompson  i 

Dietetic  Treatment.  The  dietetic  treatment  of  appendici- 
tis, which  has  not  yet  passed  into  the  surgeon^s  hands,  should 
consist  in  giving  only  such  foods  as  will  be  thoroughly  ab- 
sorbed, leaving  as  little  residue  as  possible  to  irritate  the  lower 
bowel  and  excite  peristalsis. 

Until  the  outcome  of  the  attack  is  decided  it  is  best  to  put 
the  patient  upon  a  fluid  diet,  consisting  chiefly  of  nutritive 
broths.  Beaten  eggs  may  be  allowed,  and  a  moderate  quan- 
tity of  pancreatinised  milk,  whey,  or  buttermilk.  Cocoa  may 
be  given,  and  strained  gruels  of  rice  and  barley. 

In  recurrent  cases  the  patient  should  be  cautioned  to  eat 
moderately  and  avoid  all  coarse  or  hard  food,  such  as  grits, 
coarse  oatmeal,  tough  meats,  fibrous  vegetables,  the  skin  of 
fruits  or  potatoes  —  in  short,  everything  likely  to  overload 
the  intestine  with  accumulated  waste. 

The  operative  cases  should  have  the  diet  recommended 
after  laparotomy.  Usually  the  digestive  organs  require  al- 
most absolute  rest  for  twenty-four  hours  after  the  operation, 
and  hot  water  may  be  sipped.  No  food  at  all  should  be  given 
for  fully  six  hours  before  operation. 

^W.  Oilman  Thompson,  M.D. :  "Practical  Dietetics."  New  York.  D, 
Appleton  &  Co. 


CHAPTEK  XVIII 


DIET  IN  DISEASES  OF  THE  GENITO -URINARY  SYSTEM 

ACUTE  BRIGHT'S  DISEASE 

In  dieting  a  patient  suffering  from  acute  Bright's  disease, 
one  fact  to  be  kept  prominently  in  mind  is  the  difficulty  that 
the  system  has  in  getting  rid  of  its  waste  material  —  espe- 
cially of  its  nitrogenous  waste.  Another  point  is  that  the 
diet  should  be  such  as  to  assist  in  carrying  off  those  inflam- 
matory products  by  which  we  know  that  the  tubules  of  the 
kidneys  are  to  a  greater  or  less  extent  blocked.  The  amount 
of  nitrogenous  elements  in  foods  must  be  kept  down,  and  aid 
must  be  given  for  washing  out  the  products  of  inflammation 
from  the  uriniferous  tubules. 

Water  is  the  best  diuretic. —  Hot  water  and  hot  diluent 
drinks. 

Diluted  milk  is  the  food  that  answers  best,  and  skimmed 
milk  has  a  high  reputation  as  a  diuretic.  Buttermilk,  whey 
and  kumyss  are  useful. 

From  two  to  three  pints  of  milk,  well  diluted,  given  in  the 
twenty-four  hours,  will  in  most  cases  be  sufficient  at  flrst, 
but  if  the  disease  be  protracted  and  tends  to  become  chronic, 
a  more  liberal  allowance  of  liquid  food  must  be  ordered,  and 
broths  may  be  added  to  the  dietary.  When  milk  alone  is 
given  it  should  be  given  in  divided  quantities  at  stated  in- 
tervals —  half  a  pint  every  three  or  four  hours,  diluted  with 
half  as  much  hot  water  or  effervescing  water. 

Between  supplies  of  milk  drink  freely  of  diluent  drinks. 

Diluent  Drinks,  Plain  water,  toast  water,  barley  water, 
cream  of  tartar  and  lemon  drinks,  and  the  acid  drinks  are  all 
useful  diluents. 

Give  between  meals  and  drink  slowly, 

390 


GENITO'URINARY  SYSTEM 


391 


CHRONIC  BRIGHT'S  DISEASE 

The  kidneys  are  great  agents  in  the  work  of  excreting  ni- 
trogenous waste,  and  if  these  organs  become  clogged  with  ac- 
cumulation of  nitrogenous  waste  products  they  are  not  able 
to  perform  their  functions. 

As  soon  as  we  have  evidence  sufficient  to  prove  that  the 
kidneys  are  laboring  and  are  burdened  by  their  work^  we  must 
endeavor  to  remove  the  strain  by  regulating  the  diet ;  and  one 
clear  indication  is  to  limit  the  supplies  of  nitrogenous  foods. 

Large  amounts  of  animal  food  and  the  use  of  alcohol  must 
be  stopped,  and  better  stopped  altogether. 

In  many  cases  the  effect  of  feeding  the  patient  for  six 
weeks,  or  even  two  or  three  months,  upon  an  exclusive  milk 
diet,  is  remarkably  gratifying.  The  quantity  of  milk  to  be 
prescribed  for  an  exclusive  milk  diet  in  Bright's  disease  must 
depend  on  the  age  and  size  of  the  patient,  as  well  as  upon 
his  ability  to  take  exercise  and  use  up  force  in  muscular  en- 
ergy. If  the  patient  is  invalided  so  as  to  be  confined  to  his 
room  or  the  house,  from  five  to  seven  pints  of  milk  daily  are 
quite  sufficient.  If  the  patient  loses  weight  on  a  milk  diet, 
although  it  otherwise  agrees  with  him,  it  may  be  well  to  add 
farinaceous  food  in  the  shape  of  rice  or  bread.  In  the  worst 
cases  it  is  desirable  to  give  the  milk  at  brief  intervals, 
in  quantities  of  six  ounces,  once  an  hour  during  the  day- 
time, with  an  extra  tumblerful  at  night,  and  on  awakening 
in  the  morning. 

The  quantity  of  milk  necessary  to  support  life  for  any 
length  of  time  and  maintain  good  nutrition,  especially  if 
the  patient  is  exercising  at  all,  is  considerable^  and  he  must 
take  from  fourteen  to  eighteen,  or  even  twenty-two  six-ounce 
tumblerfuls  of  milk  in  the  twenty-four  hours. 

It  is  usually  impossible  to  commence  at  this  rate  without 
producing  gastric  disturbances  from  souring  of  the  milk  in 
the  stomach,  and  possibly  diarrhoea.  The  latter  symptom 
is  an  almost  certain  indication  that  the  milk  is  being  im- 
perfectly digested,  and  a  temporary  reduction  in  its  quantity 
is  advised. 


393 


DIET  IN  DISEASE 


As  the  patient  improves  the  milk  diet  may  be  given  up, 
but  it  should  never  be  too  suddenly  abandoned.  In  adopting 
any  other  diet  it  is  a  good  rule  never  to  let  the  nitrogenous 
food  bear  a  greater  proportion  to  the  non-nitrogenous  than 
one  to  four. 

When,  after  a  milk  diet,  the  change  is  to  be  made  to  a  more 
liberal  menu,  the  hours  of  taking  the  milk  may  be  reduced 
in  frequency,  and  some  of  the  milk  may  be  replaced  by  the 
more  hearty  food. 

DIET:  Soup, —  Vegetable  or  fish  soup,  broths  with  rice  or  barley. 

Fish. —  Raw  oysters  or  clams,  fresh  fish  broiled  or  boiled. 

Meats, —  Eat  sparingly,  chicken,  game,  fat  bacon,  fat  ham. 

Farinaceous. —  Stale  bread,  whole  wheat  bread,  toast,  milk  toast, 
biscuits,  macaroni,  rice,  cereals  of  all  kinds. 

Vegetables, —  Onion,  cauliflower,  mashed  potatoes,  mushrooms,  let- 
tuce, watercress,  spinach,  celery,  cabbage. 

Desserts. —  Ripe  raw  fruits,  stewed  fruits,  rice,  tapioca,  bread  and 
milk  puddings,  junkets,  cocoa. 

Liquids. —  Toast  water,  weak  tea,  pure  water,  peptonised  milk, 
malted  milk,  fresh  buttermilk,  milk  with  hot  water  equal  parts, 
whey,  unfermented  grape  juice. 

AVOID. —  Fried  fish,  corned  beef,  hashes,  stews,  pork,  veal,  heavy 
bread,  batter  cakes,  lamb,  mutton,  beef,  gravies,  beans,  peas,  malt 
or  spirituous  liquors,  tobacco,  coffee,  ice  cream,  cake,  pastry. 

NEPHRITIC  DIET 

Massachusetts  General  Hospital  i 

Bread,  soft  puddings  without  eggs,  all  vegetables,  except  peas  and 
beans,  fruits  of  all  kinds,  gruels  and  broths. 
AVOID. —  Meat,  eggs,  peas,  beans. 

DIET  FOR  ACUTE  NEPHRITIS,  TTRIC  ACID  GRAVE! 

Dr.  Hewes,  Massachusetts  General  Hospital  i 
Four  days.    Milk,  800  c.c;  32  per  cent,  cream,  300  c.c;  bread, 

200  gms.;  butter.    Feed  six  times  a  day  with  mixture  of  milk,  150 

gms. ;  cream,  1  oz.;  bread,  l^  slice. 

Fifth  day  adopt  the  following:    Milk,  800  c.c;  cream,  300  c.c; 

rice,  50  gms.;  tapioca,  50  gms.;  bread,  100  gms.    Occasionally  ice 

cream  or  custard. 

^Diet  used  at  the  Massachusetts  General  Hospital,  Boston,  Mass.  Di, 
Hewes,  Physician  to  Out-Patients,  Massachusetts  General  Hospital. 


GENITO-URINARY  SYSTEM  393 


Vary  diet  from  day  to  day  in  above  limits.  If  oedema  is  present 
and  fails  to  disappear  change  above  to  dry  salt-free  diet.  At  the 
start  give  no  more  liquid  than  above;  after  the  oedema  is  gone 
water  can  be  given  as  desired. 

Special  Dry  Salt-Free  Diet,  Morning.  Salt-free  bread,  2  slices 
(toasted  if  desired)  ;  an  abundance  of  salt-free  butter;  maple  syrup 
if  desired.  10  A.  M.  Rice  with  small  amount  of  cream  or  sugar 
(no  syrup). 

Noon.  Mashed  potatoes  with  butter,  no  salt;  salt-free  bread,  2 
slices ;  salt-free  butter.    4  p.  m.    Rice,  tapioca,  or  baked  custard. 

Supper.  Salt- free  bread,  2  slices;  salt-free  butter;  2  eggs,  soft 
cooked;  1  orange  daily. 

Caution.  Limit  liquids  to  one  pint  a  day,  including  milk  and 
water. 

Salt-Free  'Nephritic  Diets  (Halpin).  No.  1.  Milk,  1500-2000  c.c; 
white  salt-free  bread,  400-500  gms.;  butter  (salt-free),  40  gms.;  eggs, 
4-6.     (5-6  gms.    NaCL  contained.) 

No.  2.  (Widal).  Salt-free  bread,  200  gms.;  salt-free  butter,  50 
gms.;  salt-free  beans  or  rice,  250  gms.;  meat,  200  gms.  (beef,  chicken, 
or  mutton);  sugar,  40  gms.  (1500  calories).  (1-2  gms.  NaCL  con- 
tained. ) 

No.  3.  Potatoes,  700  gms.;  salt-free  bread,  200  gms.;  salt-free 
butter,  50  gms.;  cream  cheese,  50  gms.  (2000  calories.)  (1-2%  gms, 
NaCL  contained.) 

No.  4.  Potatoes,  1000  gms.  without  salt;  meat,  400  gms.  without 
salt;  salt-free  butter,  80  gms.;  sugar,  100  gms.  (2000  calories). 
(1-2  gms.  NaCL  contained.) 

No.  5.  Potatoes,  16  oz.  (without  salt)  ;  rice,  6  oz.  (without  salt)  ; 
meat,  4  oz.  (without  salt);  cream,  8  oz. ;  eggs,  2  (without  salt); 
sugar  to  taste. 

CONVULSIONS  IN  BRIGHT'S  DISEASE 

Convulsions  in  Briglit's  Disease.  In  the  course  of  Briglit's 
disease  convulsions  and  unconsciousness  may  occur.  The 
course  to  adopt  is  to  encourage  the  action  of  the  skin,  there- 
fore place  the  patient  in  bed  between  warm  blankets^  pack 
hot  water  bottles  around  him^  and  send  for  medical  assist- 
ance.—  During  this  period  the  patient  should  live  upon  the 
exclusive  milk  diet. 


394 


DIET  IN  DISEASE 


ALBITMINTJRIA 

Thompson  i 

Dietetic  Treatment.  The  frequent  return  of  functional 
albuminuria  should  be  regarded  as  an  indication  of  special 
weakness  of  the  kidneys  in  the  same  way  that  frequent 
glycosuria  invites  suspicion  of  the  strength  of  the  digestive 
power  of  the  liver,  and  it  demands  a  careful  regulation  of 
the  diet.  Meat  should  be  reduced  in  quantity,  or  temporarily 
forbidden,  as  well  as  all  forms  of  alcoholic  drinks,  or  other 
substances  liable  to  produce  renal  irritation,  and  the  diet 
should  consist  chiefly  of  fruits,  vegetables,  and  milk.  Care- 
ful attention  must  be  paid  to  increasing  the  activity  of  the 
bowels. 

When  functional  albuminuria  is  observed  in  children  and 
adolescents,  it  is  not  necessary,  nor  is  it  advisable  in  ordi- 
nary cases,  to  wholly  exclude  nitrogenous  food,  but  it  should 
be  restricted,  especially  in  regard  to  eating  butcher's  meat 
and  eggs,  and  the  evening  meal  should  be  made  very  simple, 
consisting  of  food  such  as  bread,  crackers,  rice  or  porridge, 
and  milk. 

^W.  Oilman  Thompson,  M.D. :  "Practical  Dietetics."  New  York.  D. 
Appleton  &  Co. 


CHAPTER  XIX 


DIET  IN  MISCELLANEOUS  AFFECTIONS 

NERVOUS  DISORDERS 

Dietetic  Treatment.  The  first  thing  to  be  done  for  a  per- 
son suffering  from  nerve  exhaustion  is  to  adopt  a  dietary 
and  a  habit  of  life  that  will  rebuild  the  nerve  cells.  The 
lost  energy  must  be  gently  and  slowly  "  coaxed  ^'  back  —  not 
through  medicines,  but  through  proper  environments,  proper 
employment  and  proper  food.  There  is  no  disease  that  re- 
quires so  little  medicine  as  nerve  exhaustion.  The  dietary 
should  be  simple  and  nutritious,  abounding  in  lettuce,  pars- 
ley and  the  fresh  green  edibles  in  season.  If  there  is  much 
intestinal  disturbance,  potatoes  and  foods  that  are  rich  in 
starch  should  be  discarded.  Active  stimulants  should  be  en- 
tirely eschewed.  Take  freely  of  unfermented  grape  juice, 
malted  milk  and  Sanatogen  in  milk  or  Vichy. 

In  functional  nervous  disease,  such  as  hysteria  and  hy- 
pochondriasis, the  appetite,  muscular  elasticity,  and  mental 
powers  will  often  be  observed  to  be  deficient  in  the  early  part 
of  the  day,  and  to  recover  their  tone  in  the  evening.  At  this 
latter  time,  therefore,  it  is  advisable  to  make  the  principal 
meal. 

FUNCTIONAL  DISORDERS  OF  THE  LIVER  (BILIOUSNESS) 

DIET:  Soups, —  Light  broths,  vegetable  soups,  with  crackers  or  a 
little  toasted  bread. 

Fish. —  Broiled  or  boiled  fresh  white  flesh  fish,  raw  oysters. 

Meats. —  Eat  very  sparingly  of  lean  mutton,  lamb,  chicken  or 
game. 

Farinaceous. —  Whole  wheat  bread,  graham  bread,  dry  toast,  crack- 
ers, cereals,  tapioca,  arrowroot  (well  cooked). 

Vegetables. —  Mashed  potatoes  —  almost  all  fresh  vegetables  (well 
cooked),  plain  salads  of  watercress,  lettuce  and  dandelions. 

395 


396 


DIET  IN  DISEASE 


Desserts. —  Plain  milk  pudding  of  tapioca  or  cornstarch,  junkets, 
stewed  or  fresh  fruits  (all  without  sugar). 

Liquids. —  Weak  tea  or  coffee  (without  sugar  or  cream),  hot  water, 
pure,  plain  or  aerated  water. 

AVOID. —  Articles  of  diet  that  are  rich  and  highly  seasoned,  as 
curries,  pies  and  pastry,  strong  soups,  foods  rich  in  fats,  salmon, 
herrings,  eels,  mackerel,  and  other  fish  of  an  oily  nature,  elaborate 
entrees,  also  rich  sweets  and  creams,  cheese,  dried  fruits  and  nuts, 
malt  liquors,  sweet  wines,  such  as  champagne,  Madeira,  brown 
sherry  and  port. 

DIET  IN  SKIN  DISEASES 

Nearly  all  affections  of  the  skin  of  constitutional  or  reflex 
(gastro-intestinal)  origin,  especially  acne,  eczema,  psoriasis, 
seborrhoea  capitis,  pruritus,  urticaria,  etc.,  improve  under 
dietetic  measures  and  often  recover  under  these  alone. 
While  no  special  plan  applies  to  all,  the  elimination  of  sugar 
and  sweets  of  all  kinds,  and  substances  rich  in  fat,  as  cheese, 
nuts,  fried  articles,  etc.,  is  essential.  Pure  fats  like  butter, 
cream,  salad  oil,  etc.,  are,  however,  well  enough  in  small 
amounts.  Malt  liquors  and  sweet  wines  disagree,  largely 
because  of  the  sugar  therein;  but  alcohol  itself  is  also  prej- 
udicial in  many  cases. 

It  is  well  to  take  all  food  in  small  rations,  and  masticate 
it  thoroughly;  for  the  prejudicial  effect  of  food  in  skin  dis- 
eases is  often  directly  attributable  to  fermentation,  favored 
by  atony  of  the  digestive  tract,  dilated  stomach,  constipa- 
tion, etc.  Physical  exercise  is  of  great  benefit  in  most  of 
these  cases. 

The  diet  and  other  regimen  in  skin  diseases  is  much  like 
that  for  obesity,  gout  and  diabetes.  All  these  metabolic  dis- 
orders tend  to  produce  skin  diseases. 

DIET  IN  HEART  DISEASE 

In  disease  of  the  heart  which  has  passed  the  period  of  com- 
pensatory activity,  so  that  the  organ  is  no  longer  able  to 
discharge  its  functions  perfectly,  it  is  highly  important  that 
the  stomach  be  not  overloaded  by  heavy  meals,  and  that  the 
likelihood  of  flatulency  be  minimized  as  much  as  possible  by 


MISCELLANEOUS  AFFECTIONS  397 


care  in  eating,  for  distention  of  the  stomach  from  any  cause 
may  be  quickly  felt  by  the  pressure  upon  the  weakened  heart. 
Many  fatalities  come  about  in  this  manner;  hence  meals 
should  be  small,  repeated  when  necessary.  The  food  should 
be  concentrated  and  should  contain  little  waste  material. 
Certain  articles  of  food  prone  to  ferment  should  be  excluded, 
the  patient^s  own  experience  being  the  best  guide. 

On  the  other  hand,  it  is  also  important  to  avoid  increasing 
the  blood  pressure  by  giving  too  much  water,  which  should 
be  kept  within  a  certain  daily  limit  conformable  to  the  good 
results  obtained.  Patients  should  not  try  to  live  on  milk 
or  take  any  mineral  water  cure.  Anything  which  produces 
thirst  —  like  salted  food,  spices,  etc.,  should  be  avoided,  as 
should  exposure  to  very  hot  weather. 

DIETETIC  MANAGEMENT  OF  SURGICAL  CASES 

Not  much  special  attention  is  paid  to  dietetics  until  a  day 
or  two  before  operation,  with  the  exception  of  stomach  cases. 
Whenever  a  patient  is  to  be  operated  on  for  a  stomach  affec- 
tion, many  surgeons  advocate  the  free  use  of  articles  rich  in 
vegetable  acids,  believing  that  such  articles  are  natural  anti- 
septics for  the  stomach  and  intestines.  These  substances, 
while  technically  acids,  are  quickly  changed  to  alkalies  in 
the  body,  and  tend  to  lessen  the  total  acidity  of  the  latter. 
Some  German  surgeons  even  allow  such  patients  to  eat  freely 
of  sauerkraut,  sour  milk,  etc. 

In  other  cases,  the  patient  is  placed  in  bed,  or  is  in  com- 
plete rest  for  several  days,  and  fed  on  very  simple  and  nutri- 
tious articles  in  moderate  quantities  only.  The  old  custom 
of  fattening  or  building  patients  up  before  operating  on  them 
has  largely  died  out.  If  the  bad  general  state  of  the  patient 
is  due  to  the  condition  which  is  to  be  operated  on,  nothing 
is  gained  by  such  attempts.  In  the  case  of  a  rapidly  prog- 
ressing disease,  every  hour  lost  before  operating  may  dimin- 
ish the  chance  for  recovery,  immediate  or  ultimate.  If  the 
patient  is  in  bad  condition  for  withstanding  an  operation,  he 
may  often  be  operated  on  safely  under  local  anesthesia. 


398 


DIET  IN  DISEASE 


There  are  many  resources  to-day  for  minimizing  the  dangers 
of  shock  and  hemorrhage.  As  a  general  rule  the  sooner  a 
patient  is  operated  on^  the  better,  irrespective  of  the  urgency 
of  the  condition.  To  live  for  weeks  and  months  in  anticipa- 
tion of  an  operation  is  believed  by  its  depressing  effect  to  off- 
set alleged  attempts  at  strengthening  patients. 

When  a  general  anesthetic  is  to  be  given  the  patient  must 
fast  beforehand  to  such  an  extent  that  the  stomach  is  empty 
at  the  hour  of  anesthesia.  As  operations  are  usually  per- 
formed in  the  forenoon^  the  patient  should  take  but  little 
supper  and  no  breakfast.  Should  the  operation  be  performed 
late  in  the  day,  he  may  have  a  light  breakfast. 

In  emergency  operations,  the  patient  having  taken  food 
within  six  hours,  the  stomach  should  first  be  washed  out.. 
This  is  also  done  as  a  routine  procedure  in  all  operations 
involving  the  stomach  itself.  Water  may  be  given  at  any 
time.  After  the  operation  there  is  such  a  natural  tendency 
to  nausea  that  little  or  no  attempt  should  be  made  to  feed 
the  patient  for  some  hours.  Only  in  exceptional  cases  in 
which  the  stomach  is  not  upset  and  the  patient  complains 
of  hunger,  a  little  tea  and  toast,  or  milk  may  be  given.  In 
the  great  majority  of  cases  no  food  is  given  until  the  follow- 
ing day. 

As  soon  as  the  stomach  will  tolerate  it,  however,  simple 
nutritious  food  should  be  given  in  proper  amounts.  The 
tendency  to-day  is  toward  getting  up  early  after  operations,, 
and  against  everything  which  tends  to  make  the  patient  pas- 
sive and  bedfast.  The  patient  therefore  needs  more  food 
than  if  he  were  to  be  bedridden. 

In  patients  who  from  any  reason  are  unconscious  or  de- 
lirious after  operation,  some  plan  of  artificial  treatment  is- 
necessary,  involving  the  use  of  the  nasal,  stomach  or  rectal 
tube. 

In  any  condition  in  which  post  operative  vomiting  will 
undo  the  results  of  operation,  the  diet  should  be  extremely 
light  and  bland  until  healing  has  occurred,  and  it  may  be 
necessary  to  feed  by  the  rectum.    If  the  patient  is  unable  to 


MISCELLANEOUS  AFFECTIONS  399 


masticate  he  must  be  given  only  liquid  or  very  soft  foods. 

As  a  rule,  when  post  operative  feeding  is  left  wholly  to 
ihe  discretion  of  the  nurse,  a  certain  rule  is  adopted  as  fol- 
lows : 

No  food  at  all  for  the  first  twenty-four  hours.  Water  may 
be  given  in  sips  for  the  intolerable  thirst  and  in  addition  to 
plain  water,  the  patient  may  receive  a  swallow  of  carbonic 
water,  cracked  ice,  a  little  hot  tea  or  black  coffee,  or  some 
alcoholic  stimulant.  Toward  the  end  of  the  period  a  tea- 
spoonful  or  two  of  milk  diluted  with  lime  water  may  be 
given. 

During  the  second  twenty-four-hour  period  about  one-half 
a  pint  of  milk  or  some  other  liquid  food  may  be  given  in 
small  doses  and  this  amount  may  be  doubled  on  the  third 
<3ay. 

The  third  or  fourth  day  usually  coincides  with  normal 
bowel  action,  the  patient  having  received  laxatives  on  the  day 
preceding.  The  patient  as  soon  as  this  has  occurred  may 
go  upon  a  semi-solid  diet,  so  increased  as  to  be  regular  at 
the  end  of  a  week  or  ten  days. 

The  diet  varies  notably  with  the  patient  and  the  kind  of 
operation  and  its  outcome  and  the  responsibility  for  special 
provisions  suited  to  individual  cases  falls  upon  the  medical 
attendant  and  are  modified  from  day  to  day  under  his  direc- 
tions. 

DIET  AFTER  LAPARQTOMY,  OVARIOTOMY,  ETC. 

Thompson  i 

After  all  operations  involving  opening  the  peritoneal  cav- 
ity complete  rest  of  the  stomach  is  necessary  for  at  least  four 
or  six  hours,  and  not  infrequently  for  two  or  three  days. 
Food  and  stimulants  may  be  given  by  enemata.  If  fed  per  os 
for  the  first  three  days,  not  over  a  tablespoonful  of  pancrea- 
tinised  milk  or  milk  with  lime  water  or  barley  water  should 
be  allowed,  once  in  two  or  three  hours.    Later  the  quantity 

1 W.  Oilman  Thompson,  M.D. :  "Practical  Dietetics."  New  York.  D. 
.Appleton  &  Co. 


400 


DIET  IN  DISEASE 


may  be  increased  and  the  intervals  diminished,  and  beef  tea, 
beef  peptonoids,  and  egg  albumin  may  be  added. 

In  these  cases  the  duration  of  anesthesia  has  usually  been 
prolonged,  and  the  shock  is  considerable.  The  danger  from 
the  occurrence  of  vomiting,  fermentation  of  food,  and  flatu- 
lent distention  of  the  abdomen  is  far  worse  than  that  of  in- 
anition from  abstinence.  It  is  well  also  to  precede  the  opera- 
tion by  a  day  or  two  of  dieting  in  order  to  lessen  the  bulk 
of  intestinal  waste  matter.  To  this  end  the  diet  should, 
when  possible,  consist  chiefly  of  lean  meat  and  dry  toast, 
vegetables  and  especially  sweets  being  avoided. 

After  wounds  and  operations  affecting  the  stomach  or  in- 
testines no  food  at  all 'should  be  given  by  the  mouth.  Noth- 
ing but  a  little  cracked  ice  should  be  so  administered,  and 
all  nourishment  must  be  supplied  for  several  days  by  the 
rectum.  The  return  to  mouth-feeding  must  be  made  very 
slowly  and  cautiously  by  at  first  giving  not  over  one  or  two 
tablespoonfuls  of  pancreatinised  milk  or  beef  juice  at  a  time. 

There  is  often  much  thirst  following  operations  involving 
the  peritonaeum,  which  is  relieved  more  by  hot  fluids  than  by 
ice,  which  sometimes  irritates  the  throat  and  increases  the 
desire  for  drink.  If  there  is  danger  of  all  fluids  exciting 
emesis,  a  salt-water  enema  once  in  three  or  four  hours  will 
alleviate  thirst. 


CHAPTEE  XX 


DIET  IN  SPECIAL  CONDITIONS 
MOTHERHOOD 

DIET  IN  PREGNANCY 
Thompson  i 

It  is  not  customary  to  adopt  any  definite  system  of  diet 
for  pregnancy  unless  complications  arise.  If  serious  vomit- 
ing occurs  in  the  early  months,  this  should  be  treated  in  the 
manner  described  in  following  article.  If  albuminuria  is 
discovered,  meat  and  other  nitrogenous  food  must  be  re- 
stricted^ in  accordance  with  the  directions  given  for  al- 
buminuria. If  the  patient  becomes  very  anaemic,  without 
albuminuria,  meat;,  eggs,  and  milk  should  be  eaten  in  abund- 
ance. 

The  "  longing  of  pregnant  women  for  various  indigestible 
articles,  such  as  pickles,  chalk,  etc.,  are  largely  mythical,  and 
occurs,  if  at  all,  only  as  an  accompaniment  of  a  general  hys- 
terical condition,  not  as  a  peculiarity  of  the  period  of  preg- 
nancy. Pregnant  w^omen,  however,  should  live  simply  and 
avoid  foods  which  are  likely  to  produce  dyspepsia,  heartburn, 
spiced  dishes,  and  heating  drinks. 

They  often  suffer  from  constipation,  in  which  case  fruits 
and  coarse  cereals,  such  as  oatmeal  or  wheaten  grits,  may  be 
of  service.  The  stomach,  especially  at  night,  should  not  be 
overloaded.  The  idea  formerly  prevalent  that  pregnant 
women  need  to  eat  food  containing  abundant  phosphates  and 
lime  salts,  to  furnish  the  embryo  with  material  for  making 

1 W.  Gilman  Thompson,  M.D. :  "Practical  Dietetics."  New  York.  D. 
Appleton  So  Co, 


401 


402  DIET  IN  SPECIAL  CONDITIONS 


bones,  as  a  hen  eats  lime  to  make  egg  shells,  is  no  longer 
accepted.  The  salts  in  question  are  sufficiently  contained 
in  an  ordinary  mixed  diet,  such  as  any  pregnant  woman  may 
eat^  if  plainly  cooked. 

Another  theory,  equally  ingenious  and  directly  opposed 
to  the  one  above  mentioned,  is  only  interesting  historically, 
for  efforts  to  aid  Nature  in  a  process  which  she  is  abundantly 
competent  to  regulate  unaided  are  now  regarded  as  futile. 
This  theory  was  that  the  agonies  of  labor  would  be  less  severe 
if  the  pregnant  woman  lived  upon  a  diet  of  fruits  and  meats, 
avoiding  bread  and  fresh  vegetables  during  gestation,  on  the 
ground  that  the  lime  salts  which  they  contain  would  favor 
early  ossification  of  the  infant's  bones,  and  thus  make  the 
labor  proportionately  difficult. 

It  will  be  observed  that  the  first  theory  favors  the  child, 
and  the  second  the  mother,  but  practically  it  has  been  found 
that  diet  has  little  or  no  influence  either  way,  so  long  as  it 
is  digestible,  nourishing  and  sufficient  to  keep  the  mother  in 
good  general  condition. 

VOMITING  —  SEASICKNESS  —  VOMITING  OF  PREGNANCY 
Thompson  i 

The  first  principle  in  the  dietetic  treatment  of  vomiting 
from  any  cause  is  to  give  the  stomach  rest.  If  it  has  been 
overloaded  with  a  large  bulk  of  food,  or  with  indigestible 
material,  it  is  well  to  encourage  emesis,  and  distressing  retch- 
ing may  be  overcome  by  taking  large  draughts  of  lukewarm 
water.  A  quart  or  two  will  rinse  out  the  stomach  and  allay 
irritation  to  a  marked  degree. 

Well  nourished  patients  when  serious  vomiting  first  occurs 
should  usually  refrain  from  taking  food  of  any  kind  for  from 
ten  or  twelve  or  even  twenty-four  hours.  Exceptions  to  this 
rule  are  sometimes  found  in  that  type  of  seasickness,  and 
sometimes  in  the  vomiting  of  pregnancy^  in  which,  as  soon 
almost  as  the  stomach  is  emptied,  there  is  a  desire  to  re- 
plenish the  loss. 

1 W.  Gilman  Thompson,  M.D. :  *' Practical  Dietetics."  New  York.  D. 
Appleton  &  Co. 


MOTHERHOOD 


403 


In  any  case  in  which  the  gastric  irritation  is  persistent, 
it  is  necessary  to  give  fluid  food,  and  only  in  small  oft-re- 
peated doses,  preferably  in  predigested  form.  The  food  is 
best  given  cold,  as  a  rule,  although  some  persons  can  relieve 
nausea  by  sipping  very  hot  water. 

A  teaspoon  of  prepared  milk,  or  in  extreme  cases  but  a 
few  drops,  given  with  a  medicine  dropper  once  in  ten  or  fif- 
teen minutes,  may  be  all  that  the  stomach  will  at  first  toler- 
ate. 

The  following  is  a  list  of  dietetic  substances  which  are 
commonly  prescribed  for  the  relief  of  nausea  and  vomiting, 
or  for  nourishment  while  those  conditions  exist:  Cracked 
ice;  pancreatinised  milk;  milk  with  sodium  bicarbonate  (ten 
grains),  and  cerium  oxalate  (five  grains);  milk  and  lime 
water;  Vichy  or  milk  with  Sanatogen;  milk  and  Vichy,  soda, 
seltzer,  or  carbonic-acid  water;  kumyss  and  zoolak;  beef  ex- 
tracts and  Liquid  Peptonoids;  Dry  Peptonoids  Soluble;  raw 
meat  pulp,  scraped;  strong  black  coffee;  sour  lemonade  or 
lemonade  and  Vichy;  clam  broth.  Dry  crackers,  dry  toast, 
and  ginger  snaps  will  sometimes  be  retained  in  seasickness, 
or  a  cracker  buttered  and  sprinkled  with  a  little  Cayenne 
pepper;  brandy  and  soda;  iced  dry  champagne;  iced  brandy 
diluted  with  water,  soda  water,  or  Apollinaris. 

Very  severe  and  protracted  cases  may  require  lavage  or 
nutrient  enemata.  Vomiting  after  abdominal  surgical  opera- 
tions is  often  controlled  by  lavage. 

DIET  FOR  THE  MOTHER  AFTER  LABOR 
Society  of  the  Lying-in  Hospital,  New  York  City  i 

Immediately  after  labor  in  a  normal  case  milk  diet  is  given 
for  the  first  six  hours ;  at  the  end  of  that  time  regular  diet. 

In  abnormal  cases  the  diet  is  ordered  by  the  physician. 

In  our  regular  diet  stewed  fruits  and  cereals  are  given 
very  frequently ;  no  veal  or  pork  is  allowed. 

In  cases  of  severe  engorgement  of  breasts,  fiuids  are  re- 
stricted; a  dry  diet  is  given,  which  consists  of  the  regular 

^Diet  used  at  the  Society  of  the  Lying-in  Hospital,  New  York  City. 


404  DIET  IN  SPECIAL  CONDITIONS 


diet  and  one  glass  of  milk  with  each  meal;  no  tea  or  coffee 
and  no  fluid  between  meals. 

In  cases  of  eclampsia  milk  is  always  given;  also  a  large 
quantity  of  water,  either  hot  or  cold,  and  cream  of  tartar 
drink. 

All  nursing  women  have  extra  quantities  of  milk. 

MET  OF  A  NURSING  MOTHER  OR  WET  NTJRSE 

Thompson  i 

The  diet  of  the  nursing  mother  or  wet  nurse  must  be  regu- 
lated to  prevent  noxious  substances  from  passing  into  the 
breast  milk,  and  to  keep  her  in  good  health,  so  that  she 
does  not  suffer  from  constipation,  indigestion,  or  anaemia. 
Her  weight  should  not  alter,  and  if  she  has  menstruated  once 
or  twice  the  milk  changes  and  may  disagree. 

If  milk  does  not  make  her  constipated  or  bilious,  she  may 
drink  it  abundantly.  She  may  take  gruels  and  meat  broths, 
and  she  should  eat  simple  nourishing  food,  meat,  eggs,  veg- 
etables, and  fruits.  The  latter,  even  if  sour,  do  not  react 
unfavorably  upon  the  child,  provided  the  mother's  digestion 
is  good,  and  they  serve  to  keep  the  child's  bowels  active.  The 
mother  should  forego  the  drinking  of  much  tea  and  coffee. 
Beer  and  wine  also  should  not  be  drunk  unless  they  are  es- 
pecially prescribed  as  a  tonic.  Wet  nurses  often  demand 
beer,  ale,  or  porter  with  their  meals  if  they  have  been  accus- 
tomed to  it;  but  the  popular  idea  that  such  beverages  are 
especially  beneficial  is  fallacious.  Malt  liquor  sometimes 
causes  the  secretion  of  more  milk,  because  more  fluid  is 
drunk,  but  the  milk  is  no  better  for  it.  A  reasonable  quan- 
tity of  fluids  should  be  drunk,  however,  or  the  secretion  of 
milk  will  suffer.  The  fluid  may  be  in  the  form  of  plain  or 
effervescing  water,  milk,  soups,  etc. 

The  mother  or  wet  nurse  should  avoid  all  fatigue,  worry, 
and  emotional  excitement  of  any  kind,  which  may  inhibit  her 
digestive  functions,  and  should  take  daily  outdoor  exercise. 

iW.  Oilman  Thompson,  M.D.:  "Practical  Dietetics."  New  York.  D. 
Appleton  &  Co. 


MOTHERHOOD 


405 


On  the  whole,  the  best  indication  for  the  dietetic  treatment 
of  the  wet  nurse  is  the  study  of  the  condition  of  the  child's 
digestion,  bowels,  and  nutrition.  A  too  meager  diet  for  the 
nurse  is  soon  evident  in  lack  of  nutrition  and  development 
of  the  infant. 

Drugs  in  Human  Milk,  Not  many  drugs  pass  unchanged 
into  the  milk  which  are  likely  to  poison  the  child  through 
its  food,  but  there  are  some  which  should  be  carefully  avoided 
on  this  account.  Such  are  belladonna,  opium,  morphine,  and 
other  alkaloids;  iodin  and  its  preparations;  mercury  and  its 
salts;  salicylic  acid. 

When,  for  any  reason,  it  becomes  necessary  to  discontinue 
the  nursing  and  to  stop  further  secretion  of  milk,  the  diet 
should  at  once  be  made  as  dry  as  possible,  and  a  minimum 
quantity  only  of  fluid  is  allowed. 


CHAPTEE  XXI 


INFANT  FEEDING 

GENERAL  CONSIDERATIONS 

Infants  may  be  fed  naturally,  artificially  or  by  a  combina- 
tion of  both  methods.  When  the  child  is  at  the  breast  of 
its  own  mother  or  another  nursing  woman,  there  is  no  indi- 
cation for  artificial  feeding  as  long  as  breast  milk  is  plentiful 
and  of  good  quality.  If  the  infant  no  longer  thrives  on 
mother's  milk  or  the  mother  is  unable  to  nurse  it,  and  there 
is  no  other  breast  milk  available,  bottle  feeding  is  then  indi- 
cated. It  goes  without  saying  that  many  infants,  chiefly 
foundlings,  have  to  be  bottle  fed  from  the  start,  but  every 
effort  should  be  made  to  secure  to  the  child  its  birthright  of 
mother's  milk. 

The  subject  of  breast  feeding  and  choice  of  a  wet  nurse 
are  discussed  thoroughly  in  special  works  which  the  nurse 
is  obliged  to  study,  and  hardly  belong  to  the  general 
subject  of  dietetics.  This  is  also  true  to  a  large  extent  of 
artificial  feeding,  because  the  physician's  orders  are  so  ex- 
plicit that  they  may  be  carried  out  by  the  mother  or  any 
intelligent  woman.  However,  cases  may  occur,  as  they  fre- 
quently do  in  hospitals,  where  the  nurse  is  largely  respon- 
sible for  the  thriving  of  the  child,  and  is  given  only  general 
instructions,  if  any,  from  the  practitioner.  For  this  reason 
a  brief  resume  of  the  whole  subject  seems  desirable. 

BREAST  FEEDING 

The  baby  is  first  allowed  to  nurse  after  the  mother  has  had 
some  hours  of  sleep  following  delivery.  This,  however,  is 
not  actual  feeding  for  the  milk  is  not  secreted  as  such  until 
the  second  twenty-four  hour  period  after  birth.    The  first 

406 


INFANT  FEEDING 


407 


flow,  called  colostrum,  differs  from  true  milk  in  its  compo- 
sition, providing  a  small  amount  of  nourishment  ready  for 
absorption  without  digestion.  The  first  attempt  at  nursing 
aids  the  mother  by  assisting  the  empty  uterus  to  contract; 
while  the  colostrum  aids  the  infant  by  stimulating  the  diges- 
tive tract  and  arousing  peristalsis.  In  addition  to  the  colos- 
trum the  infant  should  receive  only  warm  water  for  the  first 
twenty-four  hours.  Should  there  be  much  delay  in  the  secre- 
tion of  mature  milk  it  may  be  necessary  to  give  the  infant 
a  little  modified  cow^s  milk  having  a  very  low  protein  content 
(14  per  cent,  to  I/2  per  cent.). 

Under  ordinary  conditions  the  mother  begins  to  secrete 
mature  milk  by  the  second  twenty-four  hour  period.  Up  to 
the  third  or  fourth  day,  this  milk  is  mixed  with  colostrum 
in  increasingly  small  amounts,  but  this  may  be  disregarded 
in  practice.  The  child  must  be  taught  to  nurse  at  stated 
intervals,  for  fifteen  or  twenty  minutes  at  a  time,  alternating 
the  use  of  the  breasts.^ 

THE  WET  NTJRSE 

When  the  mother  is  unable  for  any  reason  to  nurse  her 
child  or  to  supply  it  with  enough  nutriment,  the  ideal  sub- 
stitute is  the  milk  of  another  nursing  mother,  who  should  be 
in  perfect  health  and  have  a  child  of  about  the  same  age  as 
the  infant  to  be  nursed.  When  the  wet  nurse  is  a  hireling 
the  moral  risk  is  very  great,  for  the  nurse's  own  child  if  still 
living  is  largely  sacrificed  for  the  good  of  the  other.  It  is 
also  difficult  to  find  a  wet  nurse  of  good  character  or  educa- 
tion. It  is  particularly  necessary  to  supervise  her  diet  for 
she  may  be  intemperate.  Her  own  child  may  be  illegitimate ; 
she  herself  may  suffer  from  some  venereal  or  parasitic  dis- 
ease. 

COMPOSITION  OF  MOTHER'S  MILK 

It  is  often  advisable  to  collect  enough  milk  with  the  breast 
pump  to  permit  of  an  analysis.  Milk  within  normal  limits 
should  average  fat,  4  per  cent.;  carbohydrates  (milk  sugar), 

^  See  table  of  feeding  according  to  age. 


408  DIET  IN  SPECIAL  CONDITIONS 


7  per  cent.,  and  protein,  1.5  per  cent.  Such  an  analysis  is 
unnecessary  when  the  infant  keeps  well  and  gains  in  weight. 
Maternal  nursing  is  of  such  vital  importance  that  artificial 
feeding  should  be  looked  upon  as  a  last  resort  and  necessary 
evil,  and  carefully  guarded  against.  If  the  mother's  milk  is 
found  to  be  poor  in  non-protein  elements  and  over-rich  in 
protein,  attempts  should  be  made  to  remedy  the  disproportion 
by  proper  treatment  for  the  mother. 

THE  HYGIENE  OF  NATURAL  FEEDING 

As  a  nursing  baby  spends  most  of  its  time  sleeping,  dur- 
ing which  state  it  grows  and  develops,  there  must  be  some 
relationship  established  between  sleeping  and  feeding.  When 
it  wakes  from  normal  causes,  it  needs  nourishment.  Every- 
thing possible  should  be  done  to  keep  it  from  being  wakened 
unnecessarily.  Hence  it  is  best  left  alone,  in  a  dark  and 
quiet  room,  with  clothing  properly  adjusted. 

The  baby  should  be  weighed  at  birth  and  at  regular  inter- 
vals. It  is  natural  for  it  to  lose  weight  for  the  first  week 
or  so,  but  by  the  end  of  the  second  week  it  should  have  re- 
turned to  its  birth  weight,  and  after  that  should  gain  steadily. 
Up  to  the  fifth  month,  it  should  gain  on  an  average  from  five 
to  eight  ounces  a  week  and  hence  should  then  weigh  double 
its  birth  weight.  During  the  next  ten  months  it  should 
again  gain  its  own  weight,  so  that  if  it  weighed  eight  pounds 
at  birth  it  should  weigh  sixteen  pounds  at  the  end  of  five 
months  and  twenty-four  pounds  at  the  end  of  fifteen  months. 
Teething,  diarrhoea,  hot  summer  weather,  etc.,  tend  to  re- 
tard somewhat  the  natural  gain.  If  it  fail  to  gain  from  no 
apparent  cause,  the  breast  milk  should  be  examined  and  a 
strict  plan  of  feeding  introduced.  If  there  is  too  little  breast 
milk,  as  very  often  happens,  the  mother  should  drink  from 
one  to  two  quarts  of  good  milk  daily,  at  regular  intervals, 
during  the  night  as  well  as  the  day  hours. 

Some  attention  should  be  paid  to  the  capacity  of  the  in- 
fant's stomach,  in  all  plans  of  systematic  feeding,  as  shown 
by  the  following  table : 


INFANT  FEEDING 


409 


CAPACITY  OF  BABY'S  STOMACH 


Newly  born 
At  1  month 
At  2  months 


about  1  ounce, 
about  2i  ounces, 
about  3g  ounces. 


from  then  on^  up  to  the  first  six  months,  the  gain  is  only 
fractional,  so  that  at  that  time  it  is  barely  four  ounces. 

One  should  bear  in  mind  that  the  baby  often  craves  water, 
rather  than  milk,  and  should  always  be  offered  it  at  intervals. 
It  takes  in  this  way  one  and  one-half  ounces  or  more  each 
day,  usually  at  the  rate  of  two  teaspoonfuls  every  four  hours. 
This  use  of  water  tends  to  prevent  overfeeding.  It  is  a  good 
plan  to  give  the  water  in  a  nursing  bottle,  as  in  this  way 
the  child  becomes  accustomed  to  its  use,  and  less  difficulty 
is  experienced  at  weaning  time,  or  when  breast  feeding  has 
to  be  partially  or  wholly  discontinued  for  any  reason. 


Up  to  two  months  of  age  the  baby  will  normally  demand 
the  breast  about  ten  times  in  twenty-four  hours,  or  roughly 
speaking,  every  two  hours,  day  and  night. 

After  the  second  month,  the  night  nursings  may  be  cut 
down  to  one,  so  that  eight  feedings  in  twenty-four  hours  will 
suffice,  intervals  from  two  to  three  hours. 

After  the  third  month,  and  up  to  the  sixth,  it  may  be  fed 
every  three  hours,  in  the  daytime  only. 

From  the  sixth  to  twelfth  month,  five  feedings  will  suffice^ 
all  in  the  daytime,  intervals  from  three  to  four  hours. 

From  the  twelfth  month  to  weaning  time,  four  feedings 
suffice,  about  four  hours  apart,  in  the  daytime  only. 

The  tendency  of  the  mother^s  milk  to  grow  scanty  is  usually 
very  marked  long  before  the  nursing  period  is  over.  As  al- 
ready stated,  she  should  use  milk  freely  as  a  milk  maker. 
The  use  of  malt  liquors  no  doubt  increases  the  milk  supply, 
but  if  the  child  has  any  ailment,  especially  of  the  skin,  this 
will  almost  surely  be  aggravated.  No  drugs  have  any  power 
to  increase  the  fiow  of  milk. 

When  the  mother's  milk  is  inadequate  and  no  other  breast 


SCHEDULE  FOR  NURSING 


410  DIET  IN  SPECIAL  CONDITIONS 


milk  is  available^  mixed  feeding  will  be  necessary.  The  baby 
receives  just  enough  artificial  food  to  make  up  the  deficit. 
This  is  only  what  happens  naturally  at  the  weaning  period, 
and  is  simply  an  anticipation  of  the  latter. 

WEANING 

Children  can  be  nursed  for  two  or  three  years,  but  in  the 
great  majority  of  cases,  a  period  not  earlier  than  twelve  or 
later  than  eighteen  months  is  chosen  to  begin  mixed  feed- 
ing, so  that  the  process  may  be  made  gradual  or  rapid  as 
circumstances  demand. 

As  there  is  absolutely  no  difference  between  artificial  feed- 
ing as  a  supplement  to  breast  feeding  and  the  same  as  an 
-entire  diet,  the  subject  of  substitute  feeding  is  usually  dis- 
cussed without  special  reference  to  the  former.  It  must 
be  remembered  that  breast  feeding  continued  too  long  be- 
comes a  confirmed  habit,  like  a  drug  habit,  against  the  in- 
fant's own  welfare.  It  then  is  necessary  to  make  it  repug- 
,    nant  by  putting  aloes,  etc.,  on  the  mother's  nipple. 

ARTIFICIAL  OR  BOTTLE  FEEDING 

When  there  is  no  breast  milk  available  for  the  newly-born 
child,  or  for  an  infant  of  any  age  during  the  nursing  period; 
or  when  the  child  has  some  breast  milk,  but  not  enough  to 
nourish  it;  or  when  it  has  reached  the  weaning  period  and 
must  be  taken  off  the  breast  either  suddenly  or  gradually, 
the  general  conditions  are  much  the  same;  viz.,  the  child 
must  be  nourished  by  some  artificial  fluid  which  closely  ap- 
proximates mother's  milk  in  composition.  .  For  this  purpose 
ass's  milk  seems  especially  suitable,  as  its  composition  and 
behavior  in  the  stomach  are  very  similar  to  human  milk ;  but 
as  a  rule,  no  better  results  are  obtained  with  any  kind  of 
foreign  milk  than  that  of  the  cow,  properly  modified  to  ob- 
tain the  right  proportion  of  protein,  fat,  and  carbohydrate. 

DIFFERENCE  BETWEEN  HUMAN  AND  COW'S  MILK 

Cow's  milk  has  a  larger  protein  content  than  human  milk, 
and  is  richer  in  mineral  matter.    Human  milk  has  a  larger 


INFANT  FEEDING 


411 


sugar  content  and  therefore  a  somewhat  sweeter  taste.  The 
fat  content  of  the  two  kinds  of  milk  is  about  the  same^,  and 
this  is  also  true  of  the  total  solids.  The  following  table  shows 
the  average  composition  of  the  two  kinds  of  milk: 


Human 

Cow's 

  87% 

87% 

  13% 

13% 

  4% 

4% 

  7% 

5% 

Protein  (see  second  table)  .... 

  1.5% 

3.5% 

  0.2% 

0.7% 

The  fat  of  cow's  milk  differs  with  the  breed  of  milch  cow, 
and  may  be  as  low  as  2  per  cent,  or  3  per  cent.  The  fat  in 
human  milk  is  quite  constant  in  amount,  but  the  protein 
content  may  vary  from  1  per  cent,  to  2  per  cent.,  the  1.5  per 
cent,  in  the  table  being  an  average. 

Human  milk,  in  comparison  with  cow's  milk,  is  very  poor 
in  casein,  but  rich  in  lactalbumin  and  hence,  when  coagulated, 
does  not  form  large  curds  like  cow's  milk.  The  relations 
between  casein  and  lactalbumin  in  the  two  kinds  of  milk  are 
shown  in  the  following  table : 

Human  Cow's 

Total  protein    1.80  3.50 

Casein   60  3.00 

Lactalbumin    1.20  .50 

The  high  protein  content  and  large  proportion  of  casein 
in  cow's  milk  are  advantageous  to  the  calf,  with  its  rapid 
rate  of  growth^  and  complex  system  of  stomachs  in  which 
large  curds  can  be  completely  digested;  but  for  the  more 
slowly-growing  baby,  whose  digestion  is  largely  intestinal, 
the  proportion  of  protein  and  the  character  of  the  curd  must 
be  modified.  The  fat  of  mother's  milk  contains  more  olein 
and  more  phosphorized  fat  (lecithin)  than  cow's  milk.  The 
lactose  is  chemically  the  same.  Freshly  drawn  cow's  milk  is 
neutral  or  amphoteric  in  reaction  to  litmus.  Basic  elements 
predominate  in  both  cow's  and  human  milk,  and  hence  they 
are  both  technically  alkaline.    The  acidity  of  cow's  milk  to 


412  DIET  IN  SPECIAL  CONDITIONS 


certain  indicators  is  due  to  the  presence  of  acid  salts,  such 
as  acid  calcium  phosphate. 

On  standing,  true  acid  is  formed  by  the  action  of  lactic 
acid  bacteria  upon  the  lactose.  For  this  reason,  cow's  milk 
frequently  reacts  acid  to  litmus.  Breast  milk  is  practically 
sterile. 

GENERAL  PRINCIPLES  OF  MILK  MODIFICATIONS 

It  must  be  constantly  borne  in  mind  that  anything  but 
mother's  milk  is  a  foreign  substance  in  the  stomach  of  the 
child,  and  even  to  make  a  mixture  agreeing  in  chemical  com- 
position with  the  natural  food  is  not  to  insure  success.  The 
general  principles  must  be  applied  in  a  special  way  to  each 
individual  case. 

The  first  step  in  modification  is  the  dilution  of  the  pro- 
tein. Few  new-born  infants  can  digest  pure  cow's  milk. 
Some  require  more  dilution  than  others.  Where  the  diges- 
tive powers  are  unknown,  it  is  wise  to  begin  with  a  low 
strength  and  advance  as  rapidly  as  the  condition  of  the  child 
will  permit.  From  14  "to  1  per  cent,  protein  is  commonly 
recommended  for  the  early  weeks. 

The  second  step  is  the  adjustment  of  the  fat.  Individual 
infants  differ  in  their  tolerance  of  fat  as  of  protein.  But 
inasmuch  as  the  chemical  and  physical  differences  are  not  as 
great  in  the  case  of  fat,  it  is  usually  not  necessary  to  reduce 
it  below  2  per  cent.,  and  it  should  approximate  the  propor- 
tion in  mother's  milk  as  rapidly  as  possible. 

When  whole  milk  is  diluted,  if  more  than  one  volume  of 
water  be  added,  the  percentage  of  fat  is  less  than  two,  and 
for  greater  fat  content,  fat  must  be  added  in  the  form  of 
cream.  Since  it  is  difficult  to  get  the  right  percentage  in 
this  way,  it  is  customary  to  select  a  milk  with  such  a  ratio 
between  the  protein  and  fat  that  diluting  one  to  the  desired 
strength  dilutes  the  other  also  to  the  required  degree.  This 
is  accomplished  by  taking  the  upper  layers  of  milk  which  has 
been  standing  five  hours  or  more  for  the  cream  to  rise.  The 
upper  layers  have  much  fat  and  little  protein;  the  lower. 


INFANT  FEEDING 


413 


much  protein  and  little  fat,  and  the  adjustment  is  readily- 
made  by  taking  a  certain  number  of  ounces  for  dilution.  In 
the  laboratory,  the  exact  fat  and  protein  content  can  be  de- 
termined by  direct  analysis. 

The  third  step  in  modification  is  the  adjustment  of  the 
milk  sugar.  This  can  usually  be  given  of  the  full  strength 
found  in  mother^s  milk  (7  per  cent.).  Since  lactose  com- 
merc-ially  prepared  from  cow^s  milk  is  of  the  same  composi- 
tion as  that  in  mother's  milk,  it  is  only  necessary  to  know 
the  percentage  already  present  in  the  mixture  to  be  fed,  and 
then  add  sufficient  to  make  the  desired  strength. 

Besides  these  three  main  steps  in  artificial  feeding,  we  may 
have  as  a  further  consideration  the  selection  of  a  diluent. 
Water  is  the  first  choice,  but  to  aid  in  the  modification  of 
the  character  of  the  curd,  cereal  waters  or  gruels,  lime  water, 
proprietary  foods,  etc.,  are  sometimes  prescribed.  Carefully 
prepared,  and  regarded  mainly  as  diluents  and  not  as  sub- 
stitutes for  milk,  the  cereals  and  prepared  foods  are  often 
useful  aids.  Lime  water  causes  the  mucin  of  the  milk  to 
swell,  and  tends  to  send  the  curd  in  soft  condition  into  the 
intestines.  It  is  also  beneficial  as  a  corrective  of  constipa- 
tion. 

WHAT  DILTTTION  TO  USE 

The  degree  of  dilution  varies  with  the  age  of  the  child. 
Advance  is  made  from  low  strength  to  higher  as  rapidly  as 
the  child  is  able  to  digest  stronger  food.  Since  it  is  usually 
necessary  to  begin  with  a  formula  weaker  than  mother's  milk, 
it  is  desirable  that  stronger  formulae  be  given  as  soon  as 
practicable  to  compensate  for  this  early  loss.  This  is  par- 
ticularly true  as  regards  mineral  constituents.  On  diluted 
cow's  milk,  the  child  gets  less  iron  and  phosphorus  than  in 
mother's  milk,  and  while  cow's  milk  is  rich  in  calcium,  it  is 
doubtful  whether  this  is  as  perfectly  utilized  as  that  in  human 
milk. 

THE  QUANTITY  TO  FEED 

The  amount  of  milk  taken  by  the  breast-fed  child  is  the 
usual  guide  as  to  quantity.    (See  Capacity  of  Baby's  Stom- 


414  DIET  IN  SPECIAL  CONDITIONS 


ach.)  Both  under-feeding  and  over-feeding  are  undesirable. 
The  best  criteria  of  proper  feeding  are  the  normal  weekly 
gain  in  weight  (averaging  at  least  four  ounces)  and  the  gen- 
eral well-being  of  the  child.  A  determination  of  the  energy 
value  of  the  diet  is  desirable  as  a  control.  For  the  first  year, 
a  child  requires  on  the  average  100  calories  per  kilogram  of 
body  weight.  Seventy  calories  per  kilogram  is  minimum  for 
existence,  and  does  not  ordinarily  provide  for  storage  in 
growth. 

LABORATORY  MILK 

With  the  development  of  the  milk  laboratory,  it  has  be- 
come possible  to  obtain  by  prescription,  pure  milk  of  any 
given  composition.  Such  milk  is  necessarily  expensive,  and 
since  slight  variations  in  the  composition  of  formulae  are  not 
serious  for  the  ordinary  healthy  child,  the  use  of  laboratory 
milk  is  largely  limited  to  sick  babies  or  those  of  rich  parents. 

HOME  MODIFICATION 

For  the  average  child,  milk  can  be  successfully  modified  at 
home.  The  chief  requirements  are  fresh  clean  milk,  absolute 
cleanliness  in  its  treatment,  and  careful  following  of  direc- 
tions in  making  up  the  feedings. 

Clean  raw  milk  is  preferable  to  any  other  kind.  Therefore 
certified  milk  should  be  used  if  it  can  be  afforded.  If  this 
is  impossible,  then  the  best  bottled  milk.  If  this  is  pasteur- 
ized, the  pasteurization  should  be  at  a  low  temperature. 
Loose  grocery  milk  should  be  avoided.  When  the  milk  comes 
into  the  house,  the  bottles  should  be  carefully  washed,  and 
set  in  the  cold  until  needed. 

All  apparatus  used  in  preparing  the  baby's  food  should 
be  kept  by  itself  on  a  tray  or  table.  Every  vessel  should  be 
washed  in  soapsuds  and  then  scalded  in  clear  water  before 
use. 

If  there  is  a  special  nursing  refrigerator,  it  should  bo 
cleansed  daily  with  soda-water. 


INFANT  FEEDING 


415 


THE  NURSING  BOTTLE 

The  tube  bottles  should  never,  under  any  con- 
sideration, be  used.  No  matter  how  carefully  these 
tubes  and  outfits  are  washed,  small  particles  of 
milk  will  remain  in  the  tiny  crevices  and  cause 
inflammation  of  the  intestines. 

Select  the  plain,  graduated  cell,  without  neck, 
wide-mouthed,  covered  with  breast-nipple.    Such  a 
bottle  can  be  thoroughly  and  easily  cleaned.    These  re- 
quirements are  met  by  the  Hygeia  nursing  bottle. 

When  filled,  the  bottles  are  corked  with  non-absorbent  cot- 
ton.^ They  are  plugged  loosely,  so  that  the  steam  may  es- 
cape, if  the  milk  is  pasteurized  in  the  bottles  before  putting 
into  the  refrigerator,  as  is  necessary  when  the  quality  of  the 
milk  is  unknown  or  when  refrigeration  is  lacking.  Before 
feeding,  the  bottle  of  milk  is  warmed  to  105°  F.  (40.5°  C), 
so  that  the  milk  may  not  chill  the  stomach  of  the  infant,  and 
thereby  suspend  digestive  processes.  After  the  nursing,  the 
bottle  should  be  carefully  rinsed  with  cold  water,  then  bottle 
and  nipple  washed  with  a  suds  of  soap  and  water.  Einse, 
boil  in  clear  borax  water  for  twenty  minutes  (nipples  for  two 
or  three  minutes),  and  set  away  in  a  porcelain  dish  filled  with 
boric  acid  solution,  one  teaspoonful  to  a  quart  of  water,  or 
they  may  be  emptied  and  filled  with  a  plug  of  sterilized  baked 
absorbent  cotton,  and  will  remain  sterile  until  ready  to  use. 

The  twenty-four-hour  supply  should  be  prepared  at  one 
time.  For  removing  the  milk  from  the  bottle  a  dipper  is 
most  satisfactory,  as  the  cream  is  not  disturbed.  A  siphon 
may  also  be  used.  The  milk  sugar  to  be  added  should  be 
dissolved  in  a  little  boiling  water  and  strained.  A  bottle 
of  sterile  water  should  be  at  hand  for  diluting  the  milk. 
The  proper  number  of  bottles  for  the  day's  feedings  (pre- 
viously sterilized)  should  be  each  filled  with  the  prescribed 
amount,  stoppered  and  put  in  the  refrigerator,  or  if  necessary, 
pasteurized  and  then  quickly  cooled. 

1  To  cork  the  Hygeia  bottle,  a  sterilizer  cap  is  used  to  cover  the  cell. 
The  cap  has  a  small  opening,  which  is  corked  with  non-absorbing  cotton. 
These  caps  are  on  sale  by  druggists. 


416  DIET  IN  SPECIAL  CONDITIONS 


FORMULAE  FOR  INFANT  FEEDING 

Many  systems  for  percentage  feeding  of  infants  have  been 
evolved.  One  of  the  simplest  is  the  top  milk  method.  The 
cream  is  allowed  to  rise.  The  upper  third  of  the  bottle  con- 
taining practically  all  the  fat^  will  contain  approximately  10 
per  cent,  of  fat;  the  upper  half  7  per  cent,  of  fat.  In  the 
upper  third,  the  ratio  of  fat  to  protein  is  3.1 ;  in  the  upper 
half,  2.1;  in  whole  milk,  1.1  (approximately). 

TOP  MILK  METHOD 
L.  Emmet  Holt  i 

Top'MilJc,  To  secure  a  milk  for  infant  feeding  which  is 
fresh  and  at  the  same  time  one  which  contains  an  extra 
amount  of  fat,  the  practice  has  come  largely  into  vogue  of 
using  the  upper  portion  —  a  third,  fourth,  or  fifth  from  milk 
purchased  and  delivered  in  bottles  —  after  it  has  stood  only 
a  few  hours.  To  this  the  term  "  top-milk  or  "  upper- 
milk  has  been  given.  Different  percentages  of  fat  may  be 
obtained  by  varying  the  amount  removed  and  the  length  of 
time  the  milk  has  been  allowed  to  stand.  Top-milk  and  thin 
cream  are  practically  identical  in  composition,  although  they 
may  differ  in  freshness. 

If  cow's  milk  from  a  mixed  herd  is  put  into  bottles  soon 
after  it  is  drawn  and  rapidly  cooled,  it  will  be  found  that 
after  four  hours  the  upper  fourth  will  contain  nearly  all  the 
fat  that  will  rise  as  cream,  and  that  the  upper  layers  will  have 
nearly  the  same  percentage  of  fat  whether  the  milk  has  stood 
for  four  hours,  for  eight  hours,  or  over  night.  This  has  been 
demonstrated  in  a  series  of  experiments  made  for  me  by 
Messrs.  Upton  &  Jeffers,  at  the  Walker-Gordon  Farm  at 
Plainsboro.  After  the  milk  had  been  standing  under  the 
conditions  mentioned,  fat-tests  were  made  with  the  Babcock 
apparatus  of  the  different  four-ounce  layers  of  bottled  milk 
which  contained  originally  4  per  cent,  of  fat.    The  different 

iL  Emmett  Holt,  M.D, :  "The  Diseases  of  Infancy  and  Childhood." 
Fifth  Edition.  Copyright,  1897,  1902,  1905,  1907,  1909.    D.  Appleton  &  Co. 


INFANT  FEEDING 


417 


layers  were  carefully  removed  with  a  siphon,  with  the  follow- 
ing results : 


Percentage  of  fat  in  — 

After  four 

After  eight 

Over  night. 

hours. 

hours. 

Upper  4  oz  

20.50 

21.25 

22.00 

,  6.00 

6.50 

6.50 

Third  4  oz  

1.50 

1.40 

1.00 

1.20 

1.00 

0.30 

Fifth  4  oz  

1.00 

1.00 

0.20 

Each  of  these  percentages  represents  the  averages,  each  test 
having  been  repeated  many  times,  110  different  tests  in  all 
having  been  made.  It  will  be  seen  that  after  four  hours 
the  composition  of  the  separate  layers  does  not  change  very 
much  with  the  period  of  standing.  With  this  knowledge,  it 
becomes  a  comparatively  simple  matter  to  secure  almost  any 
desired  percentage  of  fat  by  simply  varying  the  number  of 
ounces  removed  from  the  upper  part  of  the  quart. 

This  will  of  course  not  be  the  same  with  all  milks,  but 
will  vary  considerably  according  as  the  supply  is  from  a  good 
herd  of  selected  cattle  of  mixed  breeds  (average  4  per  cent, 
fat),  a  Jersey  or  Alderney  herd  (5.25  to  5.50  fat),  or  from 
widely  scattered  farms  such  as  make  up  the  general  supply 
of  any  large  town  or  city  (3.25  to  3.50).  It  is  therefore 
absolutely  necessary  for  the  physician  to  know  with  which  one 
of  these  he  is  dealing,  if  the  milk  for  infant  feeding  is  to 
be  modified  at  home  from  the  different  layers  of  top-milk. 
More  mistakes  are  made  just  here  than  at  any  other  step  in 
this  method  of  feeding. 

The  tables  given  below  are  sufficiently  accurate  for  home 
modification,  provided  the  fat  percentage  of  the  whole  milk 
is  known. 

From  4  per  cent.  Milk 
To  secure  approximately  a  10%  fat,  remove  the  upper  11  oz.,  or 
about  one-third. 

To  secure  approximately  a  7%  fat,  remove  the  upper  16  oz.,  or 
about  one-half. 


418  DIET  IN  SPECIAL  CONDITIONS 


From  525  to  5.50  per  cent.  (Jersey)  Milk 
To  secure  approximately  a  10%  fat,  remove  the  upper  15  oz.,  or 
nearly  one-half. 

To  secure  approximately  a  7%  fat,  remove  the  upper  24  oz.,  or 
nearly  three-fourths. 

From  3.25  to  3.50  per  cent.  Milk 

To  secure  approximately  a  10%  fat,  remove  the  upper  8  oz.,  or 
about  one-fourth. 

To  secure  approximately  a  7%  fat,  remove  the  upper  11  oz.,  or 
about  one-third. 

How  to  Obtain  the  Formulas  Required  for  General  Use. 
If  one  has  at  command  three  series  or  groups  of  formulas  in 
which  the  fat  has  certain  definite  relations  to  the  proteids, 
he  will  be  equipped  for  the  great  majority  of  cases  met  with 
in  practice.    The  three  groups  are  as  follows : 

First  Series,  those  in  which  the  fat  is  three  times  the  pro- 
teids. 

Second  Series,  those  in  which  the  fat  is  twice  the  proteids. 
Third  Series,  those  in  which  the  fat  and  proteids  are 
nearly  equal. 


Fig.  2.  Chapin's 
dipper  for  re- 
moving the  up- 

Fig.  1.  The  percentage  of  fat  in  different  layers    per     layers  of 
of  milk.  milk 


INFANT  FEEDING 


419 


Once  thoroughly  familiar  with  these  groups  of  formulas, 
variations  from  them  to  suit  the  needs  of  the  particular  case 
can  readily  be  made.  In  general^  the  First  and  Second 
Series,  in  which  the  fat  is  considerably  higher  than  the  pro- 
teids,  are  adapted  to  the  early  months,  because  at  this  period 
the  infant  as  a  rule  has  more  difficulty  in  digesting  proteids 
than  in  digesting  fat.  In  the  later  months  a  higher  propor- 
tion of  proteids  can  be  taken  with  the  same  percentage  of  fat. 
There  are,  however^  other  conditions  besides  age  which  must 
be  taken  into  account^  such  as  the  vigor  of  constitution^  the 
weight,  and  most  of  all,  the  peculiarities  of  the  child^s  diges- 
tion. It  is,  therefore,  impossible  to  say  that  at  certain 
months  certain  proportions  are  desirable,  and  certain  others 
at  another  period. 

Formulas  in  Which  the  Fat  is  Three  Times  the  Proteids. 
This  is  nearly  the  relation  which  the  fat  and  proteids  bear 
to  each  other  in  a  good  sample  of  woman^s  milk.  The  easiest 
way  to  arrive  at  this  would  seem  to  be,  first,  to  secure  some 
milk  or  milk  combination  containing  three  times  as  much  fat 
as  proteids,  and  then  dilute  this  according  to  the  infant's  age 
and  digestion.  After  such  dilution  it  will  be  necessary  only 
to  add  the  requisite  amount  of  sugar  and,  when  desired, 
lime  water  to  complete  the  modification.  This,  in  brief,  is  the 
whole  process. 

The  most  convenient  combination  for  dilution  is  one  con- 
taining 10  per  cent,  fat  and  3.3  per  cent,  proteids.  I  shall 
call  it  a  10  per  cent,  milk,  and  refer  to  it  subsequently  as 
the  primary  formula  of  the  First  Series.  The  10  per  cent, 
milk  may  be  obtained  by  removing  the  upper  portion  (see 
Fig.  1)  from  a  quart  bottle  of  milk,  as  described  (p.  417, 
418).  This  method  will  answer  for  persons  who  can  obtain 
milk  fresh  from  the  cow,  or  for  those  who  use  bottled  milk, 
provided  the  bottling  is  done  at  the  dairy  before  the  cream 
rises.  The  upper  milk  may  be  taken  off  with  a  siphon,  spoon, 
or  small  dipper  ('Fig.  2)  ;  pouring  off  is  not  so  accurate. 
For  those  who  do  not  get  their  milk  as  above  described,  the 
additional  fat  can  be  secured  by  adding  cream  to  \he  milk. 


420  DIET  IN  SPECIAL  CONDITIONS 


To  secure  a  combination  containing  10  per  cent,  fat,  equal 
parts  of  plain  milk  and  the  ordinary  (16  per  cent.)  cream 
should  be  used. 

The  next  step  is  the  manner  and  degree  of  dilution  of  the 
primary  formula.  It  is  convenient  in  our  calculation  to 
make  up  twenty  ounces  of  the  food  at  a  time.  For  such  a 
twenty-ounce  mixture  it  is  seldom  necessary  to  use  less  than 
two  ounces  of  our  10  per  cent.  milk.  When  one  wishes  to 
strengthen  the  food  he  gradually  increases  the  amount  of  the 
10  per  cent,  milk,  one  ounce  at  a  time,  making  it  successively 
three  ounces,  four  ounces,  five  ounces,  six  ounces,  etc.,  in  a 
twenty-ounce  mixture,  the  water,  of  course,  being  reduced 
by  the  same  amount. 

These  mixtures  may  readily  be  translated  into  percentages 
by  remembering  that  the  percentage  of  fat  is  always  exactly 
one-half  the  number  of  ounces  of  the  10  per  cent,  milk  used 
in  a  twenty-ounce  mixture.  Thus,  using  three  ounces  will 
give  1.5  per  cent,  fat;  four  ounces,  2  per  cent,  fat;  six 
ounces,  3  per  cent,  fat,  etc.  The  proteids  will  continue  to  be 
in  every  instance  exactly  one-third  the  fat,  as  in  the  primary 
formula. 

The  amount  of  milk  sugar  needed  to  bring  this  up  to  the 
percentage  usually  required  (5.5  to  6.5)  is  one  ounce  in  each 
twenty-ounce  mixture.  One  may  obtain  from  a  druggist  a 
box  holding  exactly  one  ounce  of  sugar,  or  may  measure  in  a 
tablespoon,  calculating  two  and  one-half  even  tablespoonfuls 
as  one  ounce.  This  sugar  is  dissolved  in  the  water  used  for 
diluting  the  milk. 

The  usual  proportion  of  limewater  added  is  5  per  cent.,  or 
one  ounce  in  a  twenty-ounce  mixture;  this  may  be  easily  in- 
creased to  any  desired  quantity.  The  foregoing  directions 
may  be  expressed  in  the  following  table : 

First  Series  of  Formulas.  Fat  to  proteids,  3  :1.  (See  p.  421.) 

Primary  Formula.  10  per  cent,  milk  —  or  fat  10  per  cent., 
sugar  4.3  per  cent,  proteids  3.3  per  cent.  Obtained  (1)  as 
upper  portion  of  bottled  milk  (p.  418),  or  (2)  equal  parts 
milk  and  (16  per  cent.)  cream. 


INFANT  FEEDING 


421 


O 
I 


o 


S  O 

CJ  O 


CO  O 


O  vo  CO  O  5 
»0  VO  00  O  '■J 

d  d  d  ^ 

«    S    ^    ;*  3 

888 

vd  vo 


T-t  CS  CN  PO  CO 


II  II  II  II  11 


CO       lO  vO 


<  o 
•o 


^  <y  V.    V.    «  5t 

S  ?  c=«  »  »  «  » 


Making  more  than  a  twenty-ounce  mixture  will  be  found 
very  simple  if  we  calculate  for  twenty-five;,  thirty,  thirty-five 
ounces,  etc.    Thus  for  twenty-five  ounces  we  add  one-fourth 


422  DIET  IN  SPECIAL  CONDITIONS 


more  of  each  ingredient ;  for  thirty  ounces  one-half  more^  etc. 
Por  twenty-five  ounces  of  eleven,  therefore,  the  exact  formula 
ivould  be :  10  per  cent,  milk,  three  and  three-quarter  ounces ; 
milk  sugar,  one  and  one-quarter  ounces;  limewater,  one  and 
one-quarter  ounces ;  water  q.  s.  to  make  twenty-five  ounces  — 
i.  e.,  twenty  ounces.^ 

Formulas  in  Wliich  the  Fat  is  Twice  the  Proteids,  Here 
we  first  obtain  a  combination,  or  primary  formula,  in  Avhich 
the  fat  and  proteids  stand  in  the  relation  of  two  to  one,  and 
then  dilute  this,  adding  milk  sugar  and  limewater  to  complete 
the  modification. 

The  primary  formula  most  conveniently  obtained  for  this 
purpose  is  one  containing  7  per  cent,  fat  and  3.5  per  cent, 
proteids,  or  a  7  per  cent.  milk.  This  we  may  get  by  removing 
the  upper  portion  from  a  quart  bottle  of  milk,  as  described  on 
page  418.  Or  in  case  milk  and  cream  are  used,  instead  of 
this  upper  milk,  it  will  be  necessary  to  add  one  part  ordinary 
(16  per  cent.)  cream  to  three  parts  milk.  The  dilution  is 
.accomplished  in  the  same  general  way  as  with  the  First 
Series. 

These  formulas  may  readily  be  translated  into  percentages 
hy  remembering  that  the  percentage  of  fat  in  any  formula  is 
-exactly  seven-twentieths,  or  about  one-third,  the  number  of 
ounces  of  the  7  per  cent,  milk  in  a  twenty-ounce  mixture. 
Thus  three  ounces  in  the  mixture  will  give  about  1  per  cent, 
fat;  five  ounces  will  give  1.6  per  cent.;  nine  ounces  about  3 
per  cent.,  etc.  In  the  following  table  these  directions  are 
-expressed : 

Second  Series  of  Formulas.    Fat  to  proteids,  2  :1. 

Primary  Formula.  7  per  cent,  milk  —  or  fat  7  per  cent., 
sugar  4.40  per  cent.,  proteids  3.50  per  cent.  Obtained  (1)  as 
upper  portion  of  bottled  milk  (p.  418),  or  (2)  by  using  three 
parts  milk  and  one  part  (16  per  cent.)  cream. 

With  these,  as  with  the  First  Series,  if  more  than  twenty 

*  For  method  of  calculating  any  number  of  ounces  of  any  formula  derived 
from  10  per  cent,  milk,  see  footnote  on  page  423. 


INFANT  FEEDING 


42a 


ounces  are  required,  we  may  make  twenty-five,  thirty,  or  forty 
ounces  by  using  of  each  ingredient  one-quarter  more,  one-half 
more,  or  twice  as  much/ 

Formulas  in  Which  the  Fat  and  Proteids  are  Nearly  Equal. 
In  general  formulas  are  more  often  used  for  healthy  infants 
during  the  later  months;  but  there  are  many  conditions  of 
disturbed  digestion  in  which  formulas  having  this  relation  of 
fat  and  proteids  are  desirable  during  the  early  months.  This 
series  of  formulas  is  obtained  by  using  as  a  starting-point 
plain  milk  and  variously  diluting  it.  The  exact  percentages, 
of  fat  and  proteids  obtained  with  the  different  dilutions  of 
milk,  and  the  amount  of  sugar  necessary  to  bring  this  up  to 
the  desired  quantity,  are  shown  in  the,  table  below.  The  sugar 
in  the  higher  formulas  is  reduced  for  the  reason  that  with 
them  the  child  will  probably  be  taking  a  considerable  part  of 
his  carbohydrates  in  the  form  of  starch. 

Third  Series  of  Formulas.    Fat  to  proteids,  8  :7. 

Primary  Formula,  Whole  milk:  Fat  4  per  cent.,  sugar 
4.5  per  cent.,  proteids  3.5  per  cent.  (When  using  Jersey  or 
Alderney  milk  add  one-fourth  water.) 

1  One  may  readily  calculate  any  formula  of  any  number  of  ounces  which, 
may  be  desired  in  either  the  first  or  the  second  series  in  the  following  way: 

There  is  wanted,  for  example,  35  ounces  of  a  mixture  containing  3  per 
cent  fat,  6  per  cent  sugar,  1.50  per  cent  proteids.  In  this  combination  the 
fat  is  twice  the  proteids.     It  will  therefore  be  derived  from  7  per  cent.  milk. 

35  (No.  ounces  needed)  X3  (percentage  fat  desired)  =  105  (parts  of  fat 
required).  105-^7  (parts  of  fat  in  milk  used)  =  15  (No.  ounces  of  7  per 
cent,  milk  needed). 

The  amount  of  sugar  required  is  found  as  follows: 

7  per  cent,  milk  has  4.40  per  cent,  sugar. 

15  X  4.40  =  66  (parts  of  sugar  in  the  milk  used  in  the  formula). 
66-^  35  =  1.88  (percentage  of  sugar  in  the  formula  of  35  ounces). 
There  is  needed,  therefore,  an  addition  of  about  4  per  cent,  of  sugar  to 
bring  it  to  the  desired  percentage. 

4  per  cent,  of  35  =  1.40  (No.  ounces  sugar  to  be  added). 


434 


DIET  IN  SPECIAL  CONDITIONS 


SO  lO  O 


5e 


<i3 


I 

O 
I 

5^ 


Go" 


Ph. 03 


o  o  o 

O  o 
NO  O  r>I 


II  11 


1-4       HH  l-H  J>       hH  I— I 

l-H  HH  ^        *^  ^l-* 


5^ 


o 


C00»00»00»i^0 

.rM^^T-ICNCMlO00O\ 

52  d  o  d  o  d  d  d  o 

cd  

o  :::::::  : 

>»IS  toddddioioo 
fiodddddddd 

^i-  :::::::  : 
Ph  : 

S8888888S 

C>jO  

c/2  :::::::  : 

4-5dddddddd 

ctJvOON'thlooOO^OO 

II  II  II  11  II  II  II  II 


c3«  - 

a 


^  «  5:   s  53 


O^S    5S    a  52 


vh-  «  «  «  ;s 


:3    «  « 


H  I— I  l-H  b>  t>  '  HH 


INFANT  FEEDING 


435 


< 
o 

D 
C/2 

Without  ; 
Dry  Sugar  \ 
0.30 
0.70 

0.40  i 
0.70  I 

1.12  i 
1.36 

0.68  i 
1.06  1 
1.42  1 
0.79  1 
1.18  i 
1.42 
1.72 
2.04 
2.73 
0.69 
0.95 
1.31 

1.78  I 
2.15  ! 
0.79 
1.05 
1.42 

1.78  j 

2.13  ' 
2.73  : 
3.38 
4.09 

4.09  ; 

4.09  J 

Milk 

u  . 

^  ^       eS  CS  CS  CS  CSC^O^CSCNCNCNCSCSCSC^CSCSCS 

^CES 

Oui 

:s.  Fat  Free  Mi 
D  With  Creams 

^       >^\^v^  \^v^  ^^^^^  ^ 

^   »  ^»       cs     O             ^     «^  ^     »  0^f0^»  0'.-^cs-<*>00\c^rqcs 

O  t/3 

S       ^          c><      cs  cs      »*)                      <0  CO 

O 

)  UNCES  ( 

y-{    »    CS  »   cororo*    ^      *    to  to  "0  >0  >0  ♦   •   u-)  lo  lO  •  •J'  »   >0  O  O  O  O  ^ 

O    *              •                   •    >0»   •    VOOVOO*   •   •   t-.t^»   »   »   •    00  00  00  00  00  00 

1-4 

TURES 
GE  OF 

Proteid 

0.25 
0.50 
0.25 
0.50 
0.75 
1.00 
0.50 
0.75 
1.00 
0.50 
0.75 
1.00 
1.25 
1.50 
2.00 
0.50 
0.75 
1.00 
1.15 
1.50 
0.60 
0.75 
1.00 
1.25 
1.50 
2.00 
2.50 
3.00 
3.00 
3.00 

•  u 

N  OS 

9  w 

Sugar 

4.50 
4.50 
5.00 
5.00 
5.00 
5.50 
5.00 
5.50 
6.00 
6.00 
6.00 
6.00 
6.00 
6.50 
6.50 
6.00 
6.00 
6.50 
6.50 
6.50 
6.00 
6.00 
7.00 
7.00 
7.00 
7.00 
7.00 
7.00 
6.00 
5.50 

-tJ    O  O  O  O  O  O  O  O  O  O  O  O  O  O  O  O  O  O  O  O  O  O  Q  o  o  o  o  o  o  o 
Ci       to  O  O  O  O  lO  to  lO  o  o  o  o  o  o  »0  to  »o  »0  lO  o  o  o  o  o  o  o  o  o  o 

O  »HC^f0^»Ov0t«»000NO»-teSf0Tt<iOvOt^00O*O'-»r^fC-<:*<«OvOt^00OsO 

426  DIET  IN  SPECIAL  CONDITIONS 

"For  25-ounce  mixtures  multiply  the  amount  of  each  ingredient  by  I14 

((  ((  ((  (6  i(  «  ((  «  (<  -^-y 

((    35  "  "         «        "      "  "  1^ 

<f    40     ^'  "  2 

«    45     «  "  "  "  "  2l^ 

*  Combination  impossible  with  strength  of  cream  indicated. 

Table  'for  Estimation  of  Fat  Percentages  in  Cream 

To  determine  the  fat  percentage  of  the  cream: 
One  quart  of  whole  milk,  of  4%  fat,  will  yield  on  an  average,  ap- 
proximately : 

Oream  10%  fat  in  upper  11  ounces  after  standing  8  hours  or  more. 
12%   "    "       "       8  "  "8      "  " 

16%  "    "      "       6      "         "  8      "  " 

(c      20%  4  "  8 

Fat-free  milk  is  the  lowest  8  ounces  after  standing  8  or  more  hours. 


A  sugar  measure  is  approximately  one  level  tablespoonful.  One 
measure  to  a  twenty-ounce  mixture  gives  2  per  cent,  of  sugar,  from 
which  fact  one  may  easily  increase  or  decrease  the  sugar  percentage 
In  any  of  the  above  formulae. 


INFANT  FEEDING 


427 


TABLE  II 

Theoretical  Basis  for  Feeding  a  Healthy  Infant 


C/3 


2.00 


Prema-  1.00 
ture 

1.50 

At 
term 
End  of 
2(iwk.  2.50 
End  of 
3d.wk.  3.00 
End  of 
4th  wk.  3.50 
End  of 
6th  wk.  4.00 
End  of 
8th  wk.  4.00 
End  of 
12th  wk4.00 
End  of 

4  mo. 
End  of 

5  mo. 
End  of 

6  mo. 
End  of 

8  mo. 
End  of 

9  mo. 
End  of 
10 mo.  4.00 
End  of 

11  mo. 
End  of 

12  mo. 


4.00 


4.00 


4.00 
4.00 


4.00 


4.00 


4  00 


4.00 
4.50 
5.00 
5.50 
6.00 
6.50 
7.00 
7.00 
7.00 
7.00 
7.00 
7.00 
7.00 
7.00 
6.00 
5.00 
4.75 


0.25 
0.25 
0.50 
0.50 
0.75 
1.00 
1.00 
1.25 
1.50 
1.50 
1.75 
2.00 
2.50 
3.00 
3  00 
3.00 
3.50 


Proteids  if 
split. 


^2 


Amount 
at  each 
feeding  in 


oz.     c.  c. 


CO  <D  . 

L  C3  5 

^  a;  O 


1^  ^ 


0.25  0.25 

0.50  0.25 

0.50  0.25 

0.50  0.25 

0.75  0.25 

0.75  0.50 

0.90  0.60 

0.90  0.75 

0.90  1.00 

0.75  1.25 


K-^  3.75- 
22.50 


1 

2 

'23^ 

3 

3 

3H 
4 

sy2 

6 
7 


30 
60 
75 
90 
90 
105 
120 
135 
165 
180 
210 
240 
240 
300 
300 


1-lH  24-18 


2 
2 
2 
2 

2V2 

lYi 

3 
3 
3 
3 
3 
3 
3 


10 
10 


iyofe.— The  data  giv- 
en in  this  table  are  sim  - 
ply  a  guide  to  the  rule 
for  feeding  of  the  aver- 
age healthy  baby  .They 
are  only  approximate, 
and  not  intended  to  be 
followed  in  cases  of 
difficult  feeding,  with- 
out due  consideration 
to  the  individual  re- 
quirements. 


438  DIET  IN  SPECIAL  CONDITIONS 


TABLE  III 

Method  of  Calculating  Whey  Mixtures  from  the  Card 

The  percentages  of  fats,  proteids,  and  lime-water  are  calculated  by 
the  card.    Three-fourths  (%)  of  the  proteid  in  the  formula  chosen 
will  be  caseinogen,  and  one-fourth  (3^)  whey  proteids,  that  is, 
Formulae  calling  for  0.25  proteid  give  approximately  0.20  caseinogen. 

a  «      u  «  a  u  « 

a  «     «    100     "       "  "  0.75  " 

a  u      u    125      "         "  "  1.00  " 

«  a       a     1  5Q    .  «  u  u  1  20  " 

To  calculate  the  additional  amount  of  whey  needed  to  make  the  de- 
sired whey-proteid  percentage, 
Let  W  =  number  of  ounces  of  whey  needed. 

"    Y  =  percentage  of  whey  proteid  desired. 

"    P  =  proteid  percentage  in  the  card  formula. 

"    Q  =  total  number  of  ounces  of  mixture. 

Then  (i)W=Q  [y^J  . 

The  maximum  in  the  percentage  of  whey  proteids  in  any  formula  is 
obtained  when  all  the  watery  diluent  is  replaced  by  whey. 
To  calculate  the  sugar  required  beyond  that  contributed  by  the 
cream,  milk,  and  whey, 
Let  S  =  percentage  of  sugar  desired. 
"    L= number  of  measures,  or  level  tablespoonfuls,  of  sugar  to  be 
added. 

"    Z  =  sugar  percentage  as  given  in  last  column  of  feeding  card. 
Then(2)L=Q(Sz|}=5W 

Example:  ^  Fat  4.00,  sugar  7.00,  whey  proteid  0.90,  caseinogen  0.75, 

lime-water  5.00.    Amount,  20  oz. 
Solution:    Formula  23  gives  0.75  caseinogen.    Use  16%  cream. 

Cream  =  5  ounces. 

Fat-free  milk  =  1  " 

Whey  =  20  [o.90— =13 

Lime-water    =  1  " 

Tv/r-11  20(7— 1.42)— 5X13  . 

Milk  sugar     =  — ^  -—^   =  1.16  (1%)  measures. 


INFANT  FEEDING 


439 


TABLE  IV 
Caloric  Value  of  Formulae  Given  on  Card 


No. 

1.    334  calories. 


2. 

344 

u 

3. 

401 

a 

4. 

411 

u 

5. 

421 

u 

6. 

452 

u 

7. 

458 

u 

8. 

488 

u 

9. 

520 

u 

10. 

545 

u 

No. 

11. 

555  calories 

12. 

566 

u 

13. 

576 

a 

14. 

606 

u 

15. 

626 

u 

16. 

591 

a 

17. 

601 

u 

18. 

631 

u 

19. 

642 

u 

20. 

653 

a 

No. 

21. 

642  calories. 

22. 

648 

u 

23. 

690 

(( 

24. 

710 

u 

25. 

720 

u 

26. 

741 

u 

27. 

762 

a 

28. 

782 

u 

29. 

741 

u 

30. 

720 

a 

To  Estimate  the  Caloric  Value  of  Food  Taken. 

Example  :  An  infant  takes  6  feedings  of  210  c.c  each  of  Formula 
25,  the  caloric  value  of  which  is  720.  The  caloric  value  of  the  food 
ingested  is,  then, 

X  720  =  906.2  calories. 


To  Estimate  Weight  Development  of  an  Infant. 

To  estimate  the  weight  development  of  any  infant,  calculate  as  fol- 
lows:— 

Weight  of  an  infant 

Weight  index =  

Weight  "of  average  infant  of  same  age 
Example:    An  infant  of  18  weeks  weighs  12  lbs. 

Its  weight  index  ==i%4=.85.  Its  weight  development  =  .85X100  = 
85  per  cent. 


430  DIET  IN  SPECIAL  CONDITIONS 

TABLE  V 

Methods  of  Calculating  approximately  the  Percentage  Composition 
of  a  Food  from  Known  Amounts  of  Ingredients  used 


Let  C  =  number  of  ounces  of  cream  used. 
"    M  =  number  of  ounces  of  fat-free  milk  used. 
"    L  =  number  of  measures  of  milk  sugar  (or  level  tablespoonfuls). 
"    Q  =  total  quantity  of  mixture  in  ounces. 

/^NT^  ^  ^  CXfat  percentage  of  cream 

Then  (1)  Fat  percentage       =  ^ —  

v& 

roM,   ^  'A  ^      .  3.50  (C+M). 

(2)  Proteid  percentage  =  —  — 


Q 

.  4.75  (C+M) +40  L. 

(3)  Sugar  percentage    =  q  ■ 

If  whole  milk  is  used  in  place  of  fat-free  milk,  add  to  the  quotient  in 
(1)  the  amount  of  fat  contributed  by  the  whole  milk,  standing  for 
number  of  ounces  used;  i.  e., 

M^X4. 

(4)  Fat  percentage  in  milk=  — ^ — 

Example:  A  20-ounce  mixture  consists  of  7  ounces  of  10  per  cent, 
cream,  2  ounces  of  fat-free  milk,  1  ounce  of  lime-water,  10  ounces  of 
boiled  water,  234  measures  of  sugar. 

7X10 

Solution:  Fat  percentage     =  — — —  =3.50%. 

Sugar       «  ^  4.75(7+2)+40X2K,,,3y^., 

The  fat  percentage  of  cream  must  be  calculated  by  reference  to  the 
cream  table,  page  426. 

Infant  Pood  —  Modified  Milk  Formula 

6  ounces  cream.  4  ounces  lime  water. 

7  teaspoons  sugar  of  milk.  18  ounces  filtered  or  boiled 
1  %  teaspoons  Gum  Gluten  Flour.  water. 

Thin  gluten  with  a  little  cold  water  then  add  to  the  boiled  water 
and  let  boil  15  minutes.  When  cool  add  to  the  other  ingredients. 
This  formula  is  for  4  full  sized  bottles  or  enough  for  ten  feedings, 
infant  being  fed  every  two  hours  through  the  24.  As  child  grows 
older,  reduce  the  amount  of  cream  replacing  the  same  with  milk. 


INFANT  FEEDING 


431 


FORMTTLAE  FOR  PREPARING  INFANT  FOOD  FROM  PURE  STER- 
ILIZED SUGAR  OF  MILK 

Fresh,  Pure  Milk,  1  ounce. 

(about  2  tablespoonfuls) 
Fresh  Cream,  1%  ounces. 

(about  3  tablespoonfuls) 
Sugar  of  Milk,  3l^  drachms. 

(4  even  teaspoonfuls) 
Bicarbonate  of  Sodium,  1  grain. 

(or  use  fresh  limewater,  2  teaspoonfuls) 
Water,  5  ounces. 

(iy4  gills) 

Mix  enough  for  one  day's  use,  and  sterilize.  Be  sure  feeding  bot- 
tles, nipples,  etc.,  are  kept  perfectly  clean. 

SCHEME  FOR  FEEDING  BABIES 
Society  of  the  Lying-in  Hospital,  New  York  City  i 

First  Day. —  Give  from  nursing  bottles  30  C.C.  (1  ounce)  of  6  per 
cent,  sugar  water  every  3  hours,  from  6:45  p.m.  to  9:45  p.  M., 
inclusive,  and  if  necessary  one  bottle  at  3:45  A.  M. 

Second  Day. —  30  to  45  C.C.  (1  ounce  to  1%  ounce)  of  Formula  No  I 
in  nursing  bottle,  every  2  hours  from  6:45  A.  M.  to  10:45  P.  M., 
and  3:45  a.  m. —  ten  feedings. 

Third  Day. —  Same  as  second  day. 

Fourth  Day. —  If  there  is  milk  in  mother's  breast,  nurse  every  2 
hours  as  on  second  day.  If  there  is  no  milk  in  mother's 
breast,  30  to  45  C.C.  (1  ounce  to  ounce)  of  Formula  No. 
II  every  2  hours,  as  on  second  day. 

Fifth  and  Sixth  Day. —  For  breast  fed  babies  ten  feedings  as  in  second 
day.    For  bottle  fed  babies  same  as  fourth  day. 

Seventh  to  Fourteenth  Days. —  For  breast  fed  babies  ten  feedings. 
For  bottle  fed  babies  30  to  75  C.C.  (1  ounce  to  2^4  ounces)  of 
Formula  No.  Ill  for  ten  feedings. 

Formulae 

Sugar  Solution  6  per  cent.: 

Take  30  grams  (1  ounce)  sugar  of  milk  and  dissolve  in  500  C.C. 
(1  pint)  boiled  water. 

Formula  No.  I 
Faty  0.5  per  cent.;  sugar,  6  per  cent.;  proteid,  0.5  per  cent.: 
Take  6  per  cent,  sugar  solution,  7  parts. 

^  Diet  used  at  the  Society  of  the  Lying-in  Hospital,  New  York  City. 


432  DIET  IN  SPECIAL  CONDITIONS 


Plain  milk  1  part,  60  C.C.  (2  ounces)  lime  water  for  every  500 
C.C.  (1  pint)  of  food  mixture. 

Formula  No.  II 
Fat,  1  per  cent.;  sugar,  6  per  cent.;  proteid,  0.5  per  cent.: 

Take  6  per  cent,  sugar  solution,  7  parts;  12  per  cent,  cream  % 
part;  milk  %  part. 

60  C.C.  (2  ounces)  limewater  for  every  500  C.C.  (1  pint)  of  food 
mixture. 

Formula  No.  Ill 
Fat,  1.5  per  cent.;  sugar  6  per  cent.;  proteid  0.5  per  cent.: 

Take  6  per  cent,  sugar  solution,  7  parts;  12  per  cent,  cream  1 
part.  60  C.C.  (2  ounces)  limewater  for  every  500  C.C.  (1  pint)  of 
food  mixture. 

Formula  No.  IV 
Fat,  2  per  cent.;  sugar  6  per  cent.;  proteid  0.6  per  cent.: 

Take  6  per  cent,  sugar  solution,  5  parts;  12  per  cent,  cream  1 
part. 

60  C.C.  (2  ounces)  limewater  for  every  500  C.C.  (1  pint)  of  food 
mixture. 

Formula  No.  V 
Fat,  2.5  per  cent.;  sugar  6  per  cent.;  proteid  0.8  per  cent.: 

Take  6  per  cent,  sugar  solution,  4  parts;  12  per  cent,  cream  1 
part. 

60  C.C.  (2  ounces)  limewater  for  every  500  C.C.  (1  pint)  of  food 
mixture. 

Notes 

1.  For  every  500  C.C.  (1  pint)  of  food  mixture  add  60  C.C.  (2 
ounces)  of  lime  water. 

2.  12  per  cent,  cream  is  the  top  fifth  of  a  bottle  of  milk  after  stand- 
ing about  5  hours. 

3.  It  is  the  top  200  C.C.  (7  ounces)  of  1,000  C.C.  (1  quart)  of 
milk  after  standing  about  5  hours. 

4.  If  the  milk  is  of  rich  quality  the  top  240  C.C.  (8  ounces)  can 
be  taken. 

5.  Up  to  two  weeks  the  amount  of  each  feeding  is  30  C.C.  (I 
ounce)  to  75  C.C.  (2%  ounces)  according  to  weight,  digestion  and 
capacity. 

From  two  to  five  weeks  the  amount  of  each  feeding  is  60  C.C.  (2 
ounces)  to  100  C.C.  (3l^  ounces). 

Number  of  daily  feedings  10.  From  6:45  a.m.  to  10:45  P.M. 
From  10:45  p.m.  to  6:45  A.  M.,  one  feeding  should  suffice. 


INFANT  FEEDING 


433 


PEPTOGENIC  MILK  POWDER  MODIFIES  COW'S  MILK 

by  a  physiological  process^,  makes  the  casein  of  cows^  milk  sol- 
uble and  digestible  like  the  proteins  of  mothers'  milk^  and 
gives  a  food  for  infants  which  behaves  in  the  stomach  like  the 
food  that  Nature  provides  under  favorable  conditions. 

Directions  for  Using  Peptogenic  Milk  Powder 

Formula  No,  1  —  For  Infants  of  First  Few  Weeks 
Milk,  61/2  ozs.  (%  cup).  Cream,  1  oz.  (or  "top"  milk,  2 

Water,  16  ozs.  (2  cups).  ozs.). 

Peptogenic    Milk    Powder,  IJ^ 
measure. 
The  bottle  cap  is  the  measure 

Place  the  Peptogenic  Milk  Powder  into  a  clean  saucepan,  add  the 
pure  cold  water,  mix  perfectly;  add  the  fresh  cold  milk  and  cream; 
mix  well  and  heat  with  constant  stirring  until  "  lukewarm  "  ( 95  to 
100°  F.),  not  too  hot  to  be  agreeably  borne  by  the  mouth;  keep  at 
about  lukewarm  for  8  minutes,  then  bring  quickly  just  to  boiling 
point  in  the  open  saucepan,  or  "  pasteurise  "  by  heating  to  only  160- 
165°  F.;  pour  at  once  into  a  clean  bottle,  cork  tightly,  shake  thor- 
oughly and  put  on  ice  or  in  a  very  cold  place. 

When  a  feeding  is  required,  pour  out  the  portion  and  warm  to 
proper  temperature  for  nursing;  always  shake  the  bottle  well  before 
and  after  pouring  out  a  feeding. 

Formula  No.  2  —  For  Infants  From  1      6  Months 
Milk,  8  ozs.  (1  cup)  Cream,  l-l%ozs.  (3  tablespoonfuls) . 

Water,  16  ozs.  (2  cups)      Peptogenic  Milk  Powder,  I-IV2  measure. 
Heat  this  milk  mixture  to  about  lukewarm  (95-100°  F.)  and  keep 
at  this  temperature  for  5  minutes,  then  bring  quickly  just  to  boiling 
point,  or    pasteurize  "  by  heating  to  only  160-165°  F. 

Formula  No.  3  —  For  Infants  From  6  Months  to  1  Year 
Milk,  16  ozs.  (2  cups)  Cream,  2  ozs.  (4  tablespoonfuls). 
Water,  16  ozs.  Peptogenic  Milk  Powder,  2  measures. 

Prepare  this  milk  mixture  precisely  as  in  Formula  No.  2. 


CHAPTEE  XXII 


THE  FEEDING  OF  YOUNG  CHILDREN 

Whether  the  child  be  fed  at  the  breast  or  with  the  bottle^  the 
period  from  the  tenth  to  the  fifteenth  month  is  usually  one 
of  transition.  For  the  breast-fed  baby  it  is  often  more  critical 
than  for  the  artificially  fed^  us  the  former  has  now  to  become 
accustomed  to  cow's  milk  and  to  a  different  method  of  feeding 
at  the  same  time,  unless  it  has  been  on  mixed  feeding  or  has 
learned  to  take  water  from  a  bottle.  By  the  ninth  month, 
bottle-fed  infants  may  have  cereals  added  to  the  milk  in  the 
form  of  thoroughly  cooked  gruel.  By  the  beginning  of  the 
first  year,  there  may  be  added  to  the  diet  strained  cereals  in 
the  form  of  jelly,  stale  bread,  zwieback  or  toast,  soft-cooked 
egg  (especially  the  yolk),  and  thin  cream.  Throughout  the 
growing  period,  every  child  should  get  at  least  one  quart  of 
milk  a  day.  Milk  supplies  the  elements  of  growth  liberally 
and  in  readily  available  forms.  Orange  juice  or  prune  pulp 
should  be  given  daily.  By  the  twentieth  month,  systematic 
training  in  chewing  should  begin.  In  the  latter  part  of  the 
second  year,  well-cooked,  strained  or  finely-mashed,  easily- 
digested  vegetables  are  added  to  the  diet,  and  any  mild  fruit, 
cooked  (or  fresh  if  in  perfect  condition)  and  free  from  in- 
digestible residues,  may  be  given  in  moderate  quantities.  If 
a  distaste  for  milk  arises,  the  variety  of  other  foods  should 
be  cut  down  and  every  effort  made  to  lead  the  child  back  to 
it.  Too  much  other  food,  especially  if  highly  flavored,  is  fre- 
quently the  cause  of  this  dislike. 

Meat  is  undesirable  for  young  children,  and  should  not  be 
given  before  the  fourth  year,  and  preferably  not  till  the  eighth 
or  ninth  year,  as  sufficient  protein  is  obtainable  from  milk  and 
eggs.    Sweet  fruits,  as  prunes  and  dates,  are  preferable  to 

434 


THE  FEEDING  OF  YOUNG  CHILDREN  435 


pure  sugai;,  as  they  contain  valuable  ash  constituents  and  are 
less  likely  to  destroy  the  taste  for  other  proper  food. 

Tea^  coffee^  beer,  and  even  cocoa  except  occasionally  and 
very  weak,  should  be  prohibited.  The  child  should  no  more 
expect  to  eat  the  same  food  as  an  adult  than  to  dress  like  one. 
But  his  diet  should  be  limited  in  quality  rather  than  quantity, 
as  he  requires  much  more  in  proportion  than  an  adult  on 
account  of  his  requirements  for  growth  and  his  great  activity. 
Up  to  five  years  of  age,  about  eighty  calories  per  kilogram 
seems  to  be  desirable. 

A  well-known  dispensary  sends  out  printed  instructions  for 
the  people  of  its  neighborhood,  prohibiting  all  eating  between 
meals,  and  forbidding  all  pastry,  coffee,  tea,  alcoholics  and 
carbonated  drinks,  in  the  case  of  children  of  any  age. 

Those  under  seven  years  of  age  are  allowed  no  preserved 
meats  or  fish,  no  hot  bread,  griddle  cake,  or  nuts,  no  corn, 
cucumbers  or  egg  plant. 

For  those  under  four  years  no  stews,  tomatoes,  bananas,  or 
any  fruit  in  hot  weather. 

Children  up  to  the  age  of  eighteen  months  are  to  be  limited 
entirely  to  milk,  meat  broths,  orange  juice  and  cooked  and 
strained  cereals;  with,  in  exceptional  cases,  zwieback,  biscuit 
and  soft-cooked  eggs. 

Such  education  means  much  for  the  development  of  hardy 
men  and  women.  Undernutrition  is  not  due  alone  to  pov« 
erty ;  much  of  it  comes  from  ignorance. 

GENERAL  RULES  FOR  FEEDING  YOUNG  CHILDREN 
Thompson  i 

1.  Allow  time  for  meals. 

2.  See  that  the  food  is  thoroughly  masticated. 

3.  Do  not  allow  nibbling  between  meals. 

4.  Do  not  tempt  the  child  with  the  sight  of  rich  and  in- 
digestible food. 

5.  Do  not  force  the  child  to  eat  against  its  will,  but  exam- 

^W.  Gilman  Thompson,  M.D.:  **  Practical  Dietetics."  New  York.  D. 
Appleton  &  Co. 


43G  DIET  IN  SPECIAL  CONDITIONS 


ine  the  mouth,  which  may  be  sore  from  erupting  teeth;  and 
examine  the  food,  which  may  not  be  properly  cooked  or 
flavored.    If  good  food  is  refused  from  peevishness  merely, 
remove  it  and  do  not  offer  it  again  before  the  next  time. 
6.  In  acute  illness  reduce  and  dilute  the  food  at  once. 

Table  of  Comparisons,  Food  Required  by  Child  and  Man 

A  child  under  2  requires  0.3  the  food  of  a  man  doing  moderate 
work. 

A  child  of  3  to  5  requires  0.4  the  food  of  a  man  doing  moderate 
work. 

A  child  of  6  to  9  requires  0.5  the  food  of  a  man  doing  moderate 
work. 

A  child  of  10  to  13  requires  0.6  the  food  of  a  man  doing  mod- 
erate work. 

A  girl  of  14  to  16  requires  0.7  the  food  of  a  man  doing  mod- 
erate work. 

A  boy  of  14  to  16  requires  0.8  the  food  of  a  man  doing  moderate 
work. 

Prof.  W.  0.  Atwater. 
Table  showing  Increase  of  Calories  required  for  a  Growing  Child 


Carbo- 

Age. 

Proteid. 

Fat. 

hydrates. 

Calories. 

years. 

grammes. 

grammes. 

grammes. 

42.5 

35.0 

100 

909.7 

2 

45.5 

36.0 

110 

972.4 

3 

50.0 

38.0 

120 

1050.4 

4 

53.0 

41.5 

135 

1156.8 

5 

56.0 

43.0 

145 

1224.0 

8  to  9 

60.0 

44.0 

150 

1270.0 

12  to  13 

72.0 

47.0 

245 

1736.8 

14  to  15 

79.0 

48.0  • 

270 

1877.3 

Hutchison,  p.  453.    Schroeder,  ArcMv,  fur  Hygiene,  iv.  39,  1886. 


DIETARIES  FOR  YOUNG  CHILDREN 

Starr  i 

Diet  from  the  twelfth  to  the  eighteenth  month: 

7  A.  M.,  stale  bread  soaked  in  a  breakfast  cup  of  new  milk. 
10  A.  M.,  milk,  six  ounces,  and  soda  biscuit,  or  a  thin  slice  of  but- 
tered bread. 

1  Louis  Starr,  M.D.:  "Hygiene  of  the  Nursery."  Philadelphia.  Blak- 
iston. 


THE  FEEDING  OF  YOUNG  CHILDREN  437 


2  P.  M.,  beef  tea,  six  ounces,  bread,  and  a  tablespoonful  of  rice 
and  milk  pudding. 

6  P.  M.,  same  as  first  meal. 

10  p.  M.,  a  tablespoonful  of  Mellins'  Food  in  eight  ounces  of  milk. 

In  alternation,  a  lightly  boiled  egg  with  bread  crumbs  and  six 
ounces  of  milk  may  be  given  at  7  a.  m.,  and  at  2  p.  m.  a  mashed 
baked  potato,  moistened  with  four  tablespoonfuls  of  beef  tea,  two 
tablespoonfuls  of  junket. 

Diet  from  the  eighteenth  to  the  thirtieth  month: 

7  A.  M.,  new  milk,  eight  ounces ;  the  yolk  of  an  egg  lightly  boiled ; 
two  thin  slices  of  bread  and  butter,  or  else  milk,  and  two  table- 
spoonfuls of  well-cooked  oatmeal  or  wheaten  grits,  with  sugar  and 
cream. 

11a.  m.,  milk,  six  ounces,  with  a  soda  biscuit  or  bread  and  butter. 

2  P.  M.,  one  tablespoonful  of  rare  mutton  pounded  to  a  paste, 
bread  and  butter,  or  mashed  potatoes  moistened  with  good  dish 
gravy,  a  saucer  of  junket;  or  else  a  breakfast  cupful  of  beef  tea  or 
mutton  or  chicken  broth,  a  thin  slice  of  stale  bread,  a  saucer  of  rice 
and  milk  pudding. 

6:30  P.M.,  a  breakfast  cupful  of  milk  with  bread  and  butter,  or 
soft  milk  toast.  • 

Diet  from  two  and  a  half  to  three  and  a  half  years  of  age;  children 
icho  have  cut  their  milk  teeth: 

7  a.  m.,  one  or  two  tumblers  of  milk,  a  saucer  of  thoroughly  cooked 
oatmeal  or  wheaten"  grits,  a  slice  of  bread  and  butter. 

11a.  m.  (if  hungry),  a  tumbler  of  milk  or  a  teacupful  of  beef  tea 
with  a  biscuit. 

2  P.  M.,  a  slice  of  underdone  roast  beef  or  mutton,  or  a  bit  of  roast 
chicken  or  turkey,  minced  as  fine  as  possible,  a  mashed  baked  potato 
moistened  with  dish  gravy,  a  slice  of  bread  and  butter,  a  saucer  of 
junket  or  rice  and  milk  pudding. 

7  P.  M.,  a  tumbler  of  milk  and  a  slice  or  two  of  soft  milk  toast. 

Diet  from  three  and  a  half  years  up: 

Breakfast. —  Every  day :   milk,  porridge  and  cream,  bread  and 
butter. 

One  dish  only  each  day:  Fresh  fish,  6ggs  lightly  boiled, 
poached,  eggs  scrambled,  eggs  (plain  omelet),  chicken  hash, 
stewed  kidney,  stewed  liver. 
Sound  fruit  may  be  allowed  before  and  after  the  meal,  accord- 
ing to  taste,  as  oranges  without  pulp,  grapes  (seeds  not  to  be 
swallowed),  peaches,  thoroughly  ripe  pears,  and  cantaloupes. 
Dinner. —  Every  day:  Clear  soup,  meat  roasted  or  broiled  and 
cut  into  small  pieces,  bread  and  butter. 


438  DIET  IN  SPECIAL  CONDITIONS 


Two  dishes  each  day:  Potatoes  baked,  potatoes  mashed, 
spinach,  stewed  celery,  cauliflower,  hominy,  macaroni  (plain), 
peas,  string  beans  (young),  green  corn  (grated). 

Junket,  rice  and  milk  or  other  light  puddings,  and  occasionally 
ice  cream,  may  be  allowed  for  dessert. 
Supper. —  EVery  day:    Milk,  with  toast  or  bread  and  butter, 
stewed  fruit. 

Trom  the  third  to  the  fifth  year  the  child  has  twenty  teeth, 
and  often  three  meals  a  day  suffice,  although  from  the  third  to 
"the  fourth  year  four  may  be  given.  After  three  years  of  age 
it  is  not  possible  to  lay  down  definite  rules  for  the  quantity 
of  food  allowed.  In  health  the  appetite  may  be  taken  as  a 
fair  guide,  and  the  child  will  not  eat  too  much  if  taught  to 
eat  very  slowly,  and  thoroughly  chew  each  mouthful. 

When  the  second  set  of  teeth  begin  to  replace  the  deciduous 
or  milk  teeth,  which  gradually  decay,  digestion  is  sometimes 
interfered  with  temporarily,  from  lack  of  ability  to  masticate 
thoroughly,  and  food  should  be  subdivided  before  it  is  offered 
to  the  child. 

GENERAL  PRINCIPLES  OF  FEEDING  SICK  CHILDREN 

Since  this  work  has  been  chiefly  devoted,  as  the  title  im- 
plies, to  the  relationship  between  diet  and  disease,  the  amount 
of  space  given  to  the  feeding  of  presumably  normal  children 
may  occasion  some  wonderment.  But  the  chief  difference  be- 
tween the  dietetics  of  the  infant  and  adult  lies  in  the  fact  that 
the  bottle  infant  and  the  weanling,  nominally  healthy,  have 
to  be  dieted  to  prevent  disease.  This  has  now  come  to  be 
realized  on  all  sides.  In  classic  and  mediaeval  times  an  infant 
w^hich  could  not  get  breast  milk  usually  perished.  The  wean- 
ing period  was  somewhat  less  trying,  but  millions  of  children 
must  have  succumbed  to  the  ordeal  of  changing  to  solid  food. 
Improvement  in  feeding  means  a  direct  lessening  of  infant 
mortality,  as  modern  statistics  testify. 

Colic  and  Vomiting  (Eegurgitation)  are  almost  physiolog- 
ical, so  common  is  their  occurrence;  they  do  not  arise  from 
any  single  cause,  and  the  fact  that  breast-fed  infants  suffer 
almost  as  frequently  as  the  bottle-fed,  often  more  so,  shows 


THE  FEEDING  OF  YOUNG  CHILDREN  43^ 


that  such  ailments  are  not  entirely  preventable  by  care  in  feed* 
ing.  In  breast-fed  children^  these  symptoms  are  best  con- 
trolled by  lengthening  the  period  between  feedings.  In  bottle- 
fed  children^  besides  lengthening  the  nursing  interval^  special 
pains  should  be  taken  in  the  modification  of  the  milk.  These 
symptoms  may  occur  quite  independently  of  diet.  Chilling 
of  the  body  surface^  coughing,  improper  handling,  a  too  snug 
binder,  etc.,  may  be  the  true  cause  of  the  trouble.  Even  in 
breast-fed  infants  under  ideal  conditions,  the  mother's  milk 
may  not  be  well-borne.  It  may  in  fact  be  so  rich  in  fat  and 
protein  as  to  require  dilution;  which  of  course  in  the  breast- 
fed may  be  accomplished  only  by  giving  the  infant  water  be- 
fore or  after  nursing. 

Gavage.  Of  late  years  the  use  of  the  stomach  sound  in 
feeding  sick  nurslings  has  come  into  considerable  vogue  in 
foundling  asylums  and  the  like.  This  resource  has  a  con- 
siderable range  of  application.  Thus  in  premature  infants^ 
(which  do  not  nurse  readily)  ;  in  all  infants  which  refuse  to 
nurse ;  and  in  infants  sick  from  any  cause,  especially  when  the 
nerve  centers,  swallowing  or  breathing  apparatus  are  involved, 
or  when  continuous  vomiting  is  present,  the  use  of  the  stom- 
ach tube  may  save  life.  Very  young  babies  are  fed  much 
more  readily  than  older  ones,  since  they  are  less  liable  to 
fright.  The  tube  used  is  a  soft  rubber  catheter,  which  is 
coupled  with  a  small  funnel.  The  catheter  is  first  passed 
down  the  gullet.  In  order  to  have  plenty  of  leeway,  it  is  an 
advantage  to  unite  the  catheter  to  a  second  rubber  tube  with 
a  piece  of  glass  tubing.  The  second  rubber  tube  is  then 
coupled  to  the  funnel.  If  the  case  be  one  of  vomiting,  it  is 
often  necessary  to  wash  out  the  stomach  before  the  introduc- 
tion of  nourishment,  however  given.  The  term  lavage,  used 
for  washing  out  the  stomach,  must  not  be  confounded  with 
gavage^  which  means  literally  forced  feeding.  Complete  de- 
tails will  be  found  in  works  on  obstetrics  and  obstetric  nurs- 
ing. Edgar  says  of  gavage,  that  the  infant  to  be  fed  should 
lie  on  its  back  in  the  nurse's  arms,  its  own  arms  held  to  its 
sides,  while  an  extra  assistant  steadies  the  head.    The  tube 


440  DIET  IN  SPECIAL  CONDITIONS 


having  been  passed,  the  modified  milk  or  other  nutriment  is 
poured  into  the  funnel,  and  as  the  latter  empties  itself  the 
tube  is  pinched  to  prevent  escape.  While  regurgitation  may 
occur  and  necessitate  a  repetition  of  the  act,  it  very  often 
happens  that  food  taken  in  this  manner  is  much  better  re- 
tained than  if  taken  by  nursing  the  breast  or  bottle.  The 
exertion  required  by  nursing,  the  swallowing  of  air,  etc.,  are 
avoided  in  gavage.  To  recapitulate,  the  conditions  in  which 
gavage  has  been  found  life  saving,  are  given  by  Edgar  in  the 
following  order: 

Prematurity  (especially  in  incubator  babies)  ;  after  opera- 
tions on  the  nose  and  throat;  habitual  vomiting;  pneumonia, 
diphtheria  and  scarlet  fever.  The  jaws  of  the  nursling  can 
usually  be  separated  to  receive  the  gavage-tube.  But  if  there 
is  inflammation  of  the  mouth  or  locking  of  the  jaws  (or  if 
intubation  has  been  required  for  diphtheritic  cases)  it  may  be 
necessary  to  resort  to  nasal  feeding  (see  p.  79). 

Diarrhoea.  Under  this  familiar  term,  which  includes  the 
mildest  looseness  of  the  bowels  as  well  as  the  severest  symp- 
toms of  cholera  and  dysentery,  may  be  included  the  greater 
part  of  the  morbidity  of  the  nursling.  Death  certificates  of 
babies,  especially  in  summer  months,  chiefly  specify  this  cause. 
The  diarrhoea  makes  itself  felt  in  a  variety  of  ways.  If  con- 
joined with  vomiting  we  may  term  it  a  gastro-enteritis,  and 
state  that  a  given  child  died  from  inability  to  profit  by  its 
nourishment.  But  many  infants  succumb,  not  because  their 
nourishment  is  rejected  outright,  but  rather  from  the  fact  that 
it  is  not  utilized.  We  can  understand  death  when  due  to  vio- 
lent vomiting  and  diarrhoea;  but  the  slow  death  from  non- 
utilization  of  food,  such  as  occurs  so  extensively  in  bottle-fed 
tenement  house  children,  still  remains  largely  a  mystery,  which 
has  been  explained  in  the  most  diverse  ways.  The  amount 
and  character  of  gastro-intestinal  disturbance  ^present  is  not 
sufficient,  in  many  cases  at  least,  to  explain  the  total  failure 
of  nutrition.  It  is  in  the  effort  to  combat  this  condition  that 
so  many  methods  of  feeding  have  come  into  use.  As  in  all 
stubborn  and  imperfectly  understood  conditions,  with  a  bad 


TEE  FEEDING  OF  YOUNG  CHILDREN  441 


outlook  for  recovery^  many  substances  have  been  tested^,  and 
many  recoveries  have  been  recorded.  If  a  threatening  diar- 
rhoea appears,  with  or  without  vomiting,  the  best  course  to 
pursue  at  first  seems  to  be  fasting.  Sterile  water  may  be  al- 
lowed but  milk  is  prohibited.  It  is  believed  by  some 
authorities  that  cow's  milk  or  the  milk  of  any  animal  is  poi- 
sonous in  these  cases.  Others  would  state  that  milk  is  danger- 
ous because  of  one  or  another  solid  ingredient,  or  because  it 
furnishes  a  culture  medium  for  germs.  In  any  case  some  pre- 
digested  food  like  panopepton,  or  some  cereal  decoction  like 
rice  or  barley  water  seems  better  borne.  It  may  also  be  ad- 
visable at  this  stage  to  use  certain  drugs  to  control  vomiting. 
When  the  latter  has  ceased  for  twenty-four  hours,  normal  feed- 
ing may  be  cautiously  resumed.  The  treatment  of  these  cases 
taxes  the  utmost  resources  of  the  physician,  and  the  mortality 
is  enormous.  The  nurse's  duties  lie  rather  in  the  direction 
of  prevention;  but  if  these  cases  develop,  rest  of  the  stomach 
is  imperative  at  first  and  milk  must  not  be  resumed  until  all 
symptoms  are  passed.  Diarrhoea,  dysentery  and  all  gastro- 
intestinal troubles  in  older  children  are  dieted  on  the  same 
principles  as  are  the  same  affections  in  adults. 

Constipation  in  nurslings  is  a  condition  difficult  to  over- 
come entirely  by  diet.  The  familiar  remedies  are  sugar  and 
cream,  an  excess  of  either  of  which,  over  dietetic  requirements, 
may  loosen  the  bowels.  A  prescription  of  laboratory  milk 
may  meet  this  obstacle,  or  the  corresponding  home  modifica- 
tion. Fruit  juices,  oatmeal  gruel,  etc.,  are  sometimes  em^ 
ployed. 

Marasmus  and  RicTcets  are  two  conditions  generally  in- 
cluded under  diseases  amenable  to  diet.  Infantile  Scurvy 
should  be  named  in  the  same  connection.  There  is  no  special 
regimen,  however,  for  such  affections.  A  full  normal  diet 
cannot  be  improved  on. 


CHAPTEE  XXIII 


THE  ADOLESCENT  — THE  SEDENTAKY  —  THE  AGED 

DIET  FOR  THE  ADOLESCENT 

The  growing  youth  needs  extra  protein  food  for  the  build- 
ing of  protoplasm  and  a  sufRciency  of  salts  for  the  rapidly- 
forming  tissues;  earthy  salts  for  bones^  iron  for  bloody  phos- 
phorus for  nervous  tissue  and  its  general  influence  on  growth, 
obtained  from  the  average  liberal  mixed  diet  with  milk,  eggs, 
fresh  fruit  and  green  vegetables,  so  that  no  special  plan  of 
feeding  is  required.  If  the  adolescent  lead  a  very  active  ex- 
istence, equivalent  to  hard  labor  in  an  adult,  he  will  naturally 
require  the  same  amount  of  food  with  necessary  reduction  for 
Tveight,  and  some  allowance  for  extra  protein.  Many  ado- 
lescents, however,  are  very  sluggish  and  lead  inactive  lives,  and 
need  encouragement  to  activity,  with  food  in  proportion  to 
its  degree.  Again  the  appetite  is  not  always  a  safe  guidCj, 
especially  for  girls;  for  the  period  of  adolescence  coincides 
with  the  development  of  hysterical  tendencies  which  may 
be  manifested  by  excessive  or  diminished  craving  for  food 
without  any  reference  to  the  actual  physical  demands.  An 
active  adolescent  may  have  but  little  appetite  while  a  slug- 
gish one  may  be  a  glutton,  or  may  continually  drink  water. 
The  perverted  cravings  for  substances  of  no  nutritive  value 
and  without  appetizing  quality,  which  accompany  this  period, 
are  well  known.  It  is  therefore  necessary  that  the  diet  of  this 
period  be  as  carefully  supervised  as  that  for  the  little  child. 
The  food  must  conform  to  the  subject's  physical  requirements, 
and  must  be  administered  with  discretion,  for  a  large  percent- 
age of  food  aversions  are  acquired  at  this  time,  and  it  is  es- 
sential to  the  well-being  of  the  individual,  and  the  comfort 
of  others,  that  his  eating  habits  be  normal. 

442 


'THE  SEDENTARY 


443 


DIET  FOR  THE  SEDENTARY 

No  exact  rules  can  be  laid  down  for  the  dietetics  of  the 
sedentary.  An  individual  may  lead  a  technically  sedentary 
life,  and  yet  use  up  a  great  amount  of  energy,  only  standing 
and  walking  muscles  being  in  disuse  just  as  in  a  person  whose 
occupation  requires  standing  and  walking,  little  use  may  be 
made  of  arm,  shoulder  and  trunk  muscles.  A  better  distinc- 
tion is  between  out-door  and  in-door  life,  or  quiet  and  active 
€xistence.  True  sedentary  persons  lead  both  a  quiescent  and 
an  in-door  existence,  chiefly  in  the  sitting  posture.  The  less 
the  exertion,  the  less  the  requirement  for  food.  Excess  of 
food  over  actual  demands  is  usually  manifested  by  the  putting 
on  of  flesh  or  by  the  development  of  indigestion  or  metabolic 
disturbances.  In  theory  there  should  be  no  such  thing  as  a 
permissible  diet  for  the  sedentary,  because  no  one  should 
allow  himself  to  lead  a  purely  quiescent  existence.  It  is  pos- 
sible to  compress  a  good  deal  of  active  exercise  in  a  couple 
of  hours  of  the  twenty-four,  so  that  the  sedentary  person  passes 
virtually  into  the  next  class  above,  corresponding  to  light 
active  labor  extending  through  a  number  of  hours. 

While  individual  estimates  vary,  it  is  probable  that  1600- 
2000  calories  suffice  for  the  average  individual  on  the  usual 
basis  of  145  pounds  weight  with  the  usual  reduction  for  sex. 
As  the  sedentary  person  finds  it  difficult  to  digest  heavy  arti- 
cles of  food,  the  food  should  be  easily  digestible.  Fruit  and 
succulent  vegetables  (salads)  are  usually  well  borne  by  seden- 
tary people,  as  they  induce  daily  evacuations  of  the  bowels, 
and  are  not  fattening.  They  are  the  reverse  of  condensed 
and  highly  nutritious  foods. 

DIET  FOR  THE  AGED 

As  there  is  a  radical  distinction  between  a  person  merely 
old  in  years  and  one  who  is  actually  senile,  no  dietary  can 
be  devised  to  suit  the  case  of  all  those  of  advanced  years.  A 
man  is  technically  old  at  sixty.  In  theory  he  should  require 
less  protein  in  proportion  to  carbohydrates  than  a  younger 
man.    Many  people  of  both  sexes,  however,  preserve  their 


444  DIET  IN  SPECIAL  CONDITIONS 


working  capacity  far  into  the  sixties  and  even  into  the  seven- 
ties. Many  people  can  put  on  flesh  up  to  the  age  of  sixty, 
and  it  is  very  important  that  they  do  not  do  so.  Their  regi- 
men should  be  practically  that  of  the  corpulent.  After  the 
age  of  sixty  the  weight  may  remain  at  an  equilibrium  for  some 
years,  or  with  the  advent  of  senile  change,  the  flesh  may  be- 
gin to  disappear,  this  loss  being  physiological.  At  this  period 
less  depends  on  the  selection  of  food  than  on  the  quantity 
and  thoroughness  of  mastication.  An  active,  healthy  man 
can  preserve  his  condition  by  cutting  down  the  amount  of 
food  greatly,  and  chewing  it  thoroughly.  The  demand  for 
protein  will  very  likely  be  satisfied  with  a  small  quantity. 
The  total  fuel  requirement  will  depend  upon  whether  the  in- 
dividual exercises  or  leads  a  sedentary  life.  Sedentary  elderly 
people  can  subsist  on  very  little  food,  and  do  not  differ  much 
in  this  respect  from  middle-aged  sedentary  people. 

A  senile  person  is  practically  ah  invalid,  and  his  dietetic 
demands  do  not  differ  greatly  from  those  of  other  invalids 
(aside  from  the  convalescent).  If  the  teeth  are  more  or  less 
useless^  and  mastication  cannot  be  effected  by  the  gums,  the 
individual  becomes  a  confirmed  dyspeptic.  The  problem  of 
starch  digestion  becomes  a  serious  one.  Milk  can  be  used 
largely. 

In  theory  sugars  could  partially  replace  starches.  An  ex- 
cellent food  under  the  circumstances  is  toasted  bread,  which 
may  be  dipped  in  coffee  to  soften  it.  In  toast  the  starch  be- 
comes changed  to  dextrin,  which  is  but  one  step  removed  from 
sugar.  Well-cooked  cereals,  vegetables  (potatoes,  greens,  etc.) 
and  fruits  may  be  used  in  small  quantities  in  the  expectation 
that  they  will  be  digested  by  the  pancreatic  juice. 

Special  Eegimen :  As  already  suggested,  this  cannot  differ 
in  kind  from  that  of  the  confined  invalid  or  dyspeptic. 

DIET  1 :  Soup. —  Nutritious  soups,  such  as  chicken  or  fish  pur^e, 
beef  tea,  mutton  or  chicken  broth.    Purees  of  all  kinds. 

Fish. —  White  fish  as  sole,  whiting,  smelts,  flounders,  etc.  (best 
when  boiled) . 

^Food  suitable  for  the  Aged  According  to  Yeo. 


THE  AGED 


445 


Eggs. —  Egg  lightly  cooked,  or  beaten  up  with  milk,  etc. 

Meats. —  Young  and  tender  chicken  and  game.  Other  tender 
meats.  Potted  chicken,  game  and  other  potted  meats.  Sweetbreads, 
bacon  grilled. 

Farinaceous. —  Bread  and  butter  (bread  at  least  a  day  old)  to  be 
soaked  in  tea  or  milk  or  water.  Bread  and  milk,  porridge  and  oat- 
meal gruel.  Puddings  of  ground  rice,  tapioca,  arrowroot,  sago,  maca- 
roni.   Prepared  foods  consisting  of  predigested  starches. 

Vegetables. —  Potatoes,  carrots,  spinach  and  other  succulent  veg- 
etables, stewed  celery,  boiled  onions. 

Desserts. —  Fruit  jellies,  stewed  or  baked  fruit.  Pulp  of  perfectly 
ripe  raw  fruit  in  small  quantity,  farinaceous  puddings. 

Liquids. —  Milk  in  all  forms,  and  with  the  addition  of  warm  Vichy 
or  warm  water,  fruit  juice. 


RUMFORD 

f'THE  WHOLESOME" 

Baking  Powder 

BEST  of  the  HIGH  GRADE  Powders. 


iPure  and  Wholesome.  Rumford  is  different  from  and 
superior  to  all  other  powders,  it  being  made  of  the  genuine 
Professor  Horsford's  phosphate,  thus  supplying  the  food  with 
an  element,  the  strength-giving  phosphates,  absolutely  neces- 
sary to  health.  Fine  wheat  flour  is  of  little  value  as  a  strength- 
ening food  because  it  is  deprived  of  its  phosphates  in  bolting. 
Rumford  Baking  Powder  supplies  these  phosphates. 

Perfect  ^aMng  Quality.  Its  action  in  the  dough  is 
thorough,  making  cake,  biscuit,  muffins,  etc.,  of  the  finest 
texture,  which  will  retain  their  fresh  condition  longer  than 
when  made  with  ordinary  baking  powder  or  cream  tartar. 

No  Baking  Towder^^  taste.  Rumford  contains  no 
alum  or  cream  tartar  and  gives  no  bitter  or  "baking  powder  " 
taste  to  the  food.  Biscuit,  etc.,  made  with  it  retain  the 
natural  flavor  of  the  grain  and  it  will  not  impair  the  most 
delicate  flavoring  used  in  cake,  etc. 

Every  Can  Warranted.  Rumford  will  retain  its 
strength  indefinitely  and  we  guarantee  every  can  to  give 
satisfaction  or  money  refunded. 

Heasonahle  Price.  Recent  improvements  enable  us 
to  sell  Rumford  at  a  reasonable  price,  much  less  than  the 
ordinary  high-priced  powders. 

RUMFORD  CHEMICAL  WORKS 

Main  Offices,  Providence,  R.  I. 


446 


INDEX  TO  RECIPES 


^  PAGE 

Acid  Be\t:rages  .  .  .  .110 
Acid  Phosphate  ...  113 
Acid  Phosphate  Whey  .  113 
Apple  Water  .  .  .  .115 
Bran  Lemonade  .  .  .111 
Cream  of  Tartar  Drink  .  114 
Currant  Water  .  .  .115 
Effervescent  Lemonade  .  Ill 
Egg  Lemonade  .  .  .  .121 
Eruit  Lemonade  .  .  .111 
Eruit  Punch     .     .     .  .117 

Eruitade  112 

Orape  Juice  .  .  .  .116 
"  Lemonade  .  .  .112 
"  Lithia  ....  116 
"  Nectar  .  .  .  .116 
"  Water  .  .  .  .115 
Irish  Moss  Lemonade  .  .112 
Jelly  and  Ice  .     .     .  .114 

Lemonade  Ill 

Lemon  Whey  .  .  .  .113 
Malted  Milk  Currant  Jelly  114 
Malted  Milk  with  Wine  .  114 

Orangeade  112 

Orangeade  No.  II  .  .  .112 
Pineapple  Juice  .  .  .113 
Pineapple  Lemonade  .  .111 
.Ehubarb  Water  .  .  .115 
Soda  or  Apollinaris  Lem- 
onade  Ill 

Tamarind  Malted  Milk  .  116 
Tamarind  Water   .     .  .115 

Tea  Punch  116 

Tutti  Erutti  Punch  .  .117 
White  Rock  Lemonade     .  Ill 

Wine  Whey  113 

Acid    Phosphate  (Hors- 

ford's)  478 

Acid  Phosphate  .  .  .113 
Acid  Phosphate  Whey     .  113 


447 


PAGE 

Albuminous  Beverages     .  118 
Albumin  Water     .     .  .122 
Albuminized  Clam  Water  123 
"  Grape  Juice  123 

Milk      .     .  122 
"  Orange  .     .  123 

"  Sherry    .     .  123 

Water  .  .  122 
Beef  Egg-nog  ....  120 
Coffee  Egg-nog      ...  120 

Egg  Broth  118 

"     Lemonade  .     .     .  .121 

Egg-nog  119 

Egg-nog  No.  II     .     .  .119 
Egg  and  Brandy    .     .  .120 
"     and  Rum  .     .     .  .120 
"    and  Wine  ....  120 
Grape  Yolk      ....  121 
"      Juice  and  Egg     .  122 
Junket  Egg-nog     .     .  .119 
Malted  Milk  and  Egg  .     .  121 
Mulled  Wine    ....  122 
Pineapple  Egg-nog     .     .  120 
Stokes'  Mixture     ...  121 
Albuminous  Jellies     .    .  221 

Beef  Jelly  222 

Calf's  Eoot  Jelly  ...  221 
Chicken  Broth  Jelly  .  .  222 
Panopepton  Jelly  .  .  .  208 
"  Jelly  with  Orange  209 
Peptonoids  Coffee  Jelly  .  207 
Wine  Jelly    .  205 

Apples 

Apple  Cuban  Style    .     .  280 
Custard       ...  288 
"     Tapioca  ....  300 
"     Water     .     .     .  .115 
Baked  Aples     ....  279 
Stewed  Apples  ....  279 
Apricot  and  Prune 

Sauce  280 


448 


INDEX  TO  RECIPES 


PAGE 

Arrowroot  Gruel    .    .    .  238 
Asparagus  on  Toast    .    .  268 
Soup  .     .  223-224 
Boiled  Asparagus  .     .     .  267 
Creamed  Asparagus    .     .  268 

B. 

Bacon,  Broiled   ,    .    .  .151 
Curled  Bacon   ....  151 
Baked  Custards 

Baked  or  Cup  Custard  .  288 

"      Caramel  Custard  .  •  290 

"      Custard  No.  II  .  289 


Chocolate  Custard      .     .  289 

Malted  Milk  Custard  .     .  290 

White  Custard      ...  289 

Baking  Powder  (Rumford) 

  446 

Bananas  Baked          .     .  280 

Banana  Custard     .     .     .  288 

Barley 

Barley  Gruel  ....  238 
"  Gruel  with  Broth  238 
"  Gruel  or  Jelly  .  238 
"  Jelly  ....  244 
"  Water  .  .  .  .  124 
"  Water  (for  In- 
fants)   125 

Bavarian  Cream     .     .  .210 

Beef 

Beef  Broth   219 

"    Egg-nog    ....  120 

"    Jelly   222 

"    Sandwiches    ...  260 

Broiled  Beef  Steak     .     .  149 

Maitre  D'Hotel  Butter  .  149 
Pan     Broiled  Beefsteak 

Cakes   149 

Roast  Beef   152 

Scraped  Beef    .     .     .  .217 
Beef  Preparations  .     .  .212 
Beef  Essence     .     .     .  .215 

"    Juice  .     .     .     .     .  214 

"    Juice    (for  Infants)  215 

"Tea   215 

"    Tea  Frozen   ...  216 
"    Tea     with  Hydro- 
chloric Acid  ....  216 


PAGE 

Dry  Peptonoids  Soluble  .  492 
Liquid  Peptonoids      .  .215 

Panopepton  216 

Raw  Beef  Sandwiches  .  217 
Scraped  Beef   .     .     .  .217 

Beet  Greens  269 

Beverages 

Acid  Beverages  .  .  .110 
Albuminous  Beverages  .  118 
Miscellaneous  Beverages  .  127 
Starchy  Beverages  .  .  .  124 
Birds  (Note  Poultry)  .  152 
Biscuit 

Baking  Powder  Biscuit  .  253 
Bran  Biscuit     ....  253 
"    Muffins     ....  254 
Cornmeal  Gems     .     .     .  254 
Gum  Gluten  Biscuit    .     .  252 
"     Drop  Biscuit  253 
"     Muffins    .     .  253 

Pop  Overs  254 

White  Gems     ....  254 
Blanc  Mange     ....  295 
Chocolate  Blanc  Mange    .  301 
Boiled  Frosting  ....  320 
Bouillon,  Clam  ....  174 
Clam  Bouillon  Bisque     .  175 

Bran  Tea  .137 

Bran  Lemonade  .     .     .  .111 

Brandy  and  Milk  .    .  .197 
Bread   .......  247 

Baking  Powder  Biscuit  .  253 
Boston  Brown  Bread  .     .  252 
Bran  Bread      ....  252 

"     Biscuit    ....  253 

"     Muffins    ....  254 

Cornmeal  Gems     .     .     .  254 
Entire  Wheat  Bread  .     .  251 
Gum  Gluten  Biscuit    .     .  252 
Bread     .     .  252 
"     Drop  Biscuit  253 
"     Muffins    .     .  253 

Pop  Overs  254 

White  Flour  Bread  .  .  250 
White  Gems  ....  254 
Whole  Wheat  or  Graham 

Bread  251 

Bread  Crumbs  Buttered  .  246 
Bread  Panada    ....  127 


INDEX  TO  RECIPES 


449 


PAGE 

Bread  Pudding  .  .  .  .302 
Cheese  Bread  Pudding  .  304 
Chocolate  "  "        .  303 

Gluten  Brown  Betty  .  .  304 
Jelly  Bread  Pudding  .  .  303 
Lemon  "  "       .     .  303 

Orange  "  "       .     .  302 

Plain     "  "       .     .  302 

Bread  Sauce  fob  Game  .  158 
Breakfast  Foods    .    .    .  242 

Boiled  Rice  297 

Cornmeal  Mush  .  .  .  242 
Gum     Gluten  Breakfast 

Food  242 

Hasty    Pudding    ...  242 

Hominy  243 

Oatmeal  Mush  ....  243 
Steamed  Rice  ....  298 

Broths  217 

Beef  Broth  219 

Broth  with  Grains     .  .219 
Chicken  Broth  ....  220 
Clam  Broth  No.  I  .     .     .  220 
"    Broth  No.  II     .     .  220 
Egg  Broth    (Milk)    .  .118 
"      Broth   (Hot  Water)  221 
"     Broth   (Beef  Broth)  221 
Mutton  Broth  .     .     .  .219 
Prepared  Broths    .     .  .491 
Veal   Broth      ....  220 
Butter  Balls     ....  255 
Butter  Cream    .     .     .  .165 
Buttermilk  (Artificial)  .  199 
Buttered  Crumbs    .    .    .  246 

0. 

Cake   317 

Boiled  Frosting     .     .     .  320 

Cold  Water  Sponge  Cake  .  318 

Ginger  Bread   ....  320 

Gum  Gluten  Nut  Cake  .  319 

Hot  Water  Sponge  Cake  .  319 

Marguerite  Wafers     .     .  320 

Plain  Cake   319 

Sponge   Cake    .     .     .  .318 

Carrots   268 

Boiled   268 

Creamed   268 


PAGE 

Caudle  241 

Cauliflower  268 

Boiled     .     .     .     .     .  .268 

Creamed  268 

Celery  268 

Boiled  268 

Creamed  268 

Soup  224 

"  (Diabetic)  »  .  .  225 
Toast  257 

Cereals     .    .    .     .     .    .  2^3 

Breakfast  Food  ....  242 

Gruels  238 

Starchy  Gruels      .     .     .  244 

Charlotte,  Orange  .     .  .211 

Cheese 

Cheese  Bread  Pudding     .  304 
Wafers  ....  276 
Gluten  Biscuit  Crisps  .     .  276 
Gluten  Cheese  Wafers  .  .261 

Sandwiches  259 

Chicken 

Broiled  Chicken  ,  .  .156 
Chicken  Broth  ....  220 
Broth  Jelly  .  .  222 
"  Salad  ....  274 
Creamed  Chicken  .  .  .157 
Jellied  "       ...  157 

Roast  "       ...  154 

Gravy  155 

Stuffing  154 

Trussing  154 

Scalloped  Chicken  .     .     .  157 
To  clean  Chicken  .     .  .153 
Chocolate    (  Walter  Bak- 
er's)  477 

Chocolate  Blanc  Mange  .  301 
Bread   Pudding  303 
"        Custard       .     .  289 
"        Ice  Cream  .     .  308 
Milk  Shake     .  135 
"        Sauce    for  Ice 

Cream  311 

Chocolate  Syrup     .     .  .136 
"        Vienna  Style  .  135 
Plain  Chocolate     .     .  .134 
"     Chocolate  (Ind.)    .  135 
Chops 

Chop  Broiled  in  Paper  .  151 


450 


INDEX  TO  RECIPES 


PAGE 

Prench  Chops  .  .  .  .150 
Lamb  Chops  Broiled  .  .  150 
Mutton  Chops  "  .  .  150 
Pan  Broiled  Chops  .  .150 
Cinnamon  Water  .  .  .  136 
Milk  ....  197 

Clams  172 

Albuminized  Clam  Water  123 
Clam  Bouillon  ....  174 
"  Bouillon  Bisque  .  175 
"  Broth  .  .  .  .173 
"  Broth  No.  II  .  .  220 
"  Broth  on  Toast  .  258 
"  Frapp^  .  .  .  .315 
"     Sherbet    ....  312 

"     Soup  174 

"     Stew  174 

"     Water      ....  173 
"     Water  No.  II    .     .  173 
Little  Neck  Clams      .     .  172 
Steamed  Clams      .     .  .172 
Cocoa  (Walter  Baker's)   .  477 
Breakfast  Cocoa    .     .     .  133 
Cocoa  (Ind)  .134 
Cocoa  Junket  ....  294 
Malted  Milk  Cocoa    .  .134 
Codfish 

Creamed  Codfish    ...  163 
Codfish  (Dia- 
betic)  164 

Coffee 

Boiled  Coffee    ....  132 
Coffee  (Ind.)    .     .  132 
Cereal  Coffee    .     .     .  .133 
Coffee  Egg-nog  ....  120 
Ice  Cream  ...  308 

"     Jelly  207 

"  Junket  .  .  .  .294 
Filtered  Coffee  .  .  .  .132 
"  Coffee  No.  II  .  133 
Malted  Milk  Coffee  .  .  133 
Perculator  Coffee  .  .  .131 
Peptonoids  Coffee  Jelly  .  207 
Condensed  Milk  .    .    .  .192 

Consomme  228 

Corn  Soup  224 

Cornmeal  Gems  .    .     .  .254 
"        Mush  ....  242 


PAGE 

Cornstarch  Pudding    .     .  295 
Cornstarch  Fruit  Jelly     .  295 
"         Pudding    .     .  295 
Malted  Milk  Blanc  Mange  296 
Pineapple  Cream   .     .     .  295 
Crackers 

Bran  Crackers  ....  260 
Cheese  Wafers  ....  276 
Cracker     Crumbs  (but- 
tered)  246 

Cracker  Gruel  ....  239 
Cracker  Panada     .     .     .  126 
Pudding    ...  304 
Crisped  Crackers  .  .  229 

Gluten  Cheese  Wafers      .  261 
"       Crackers     .     .     .  260 
Biscuit  Crisps      .  261 
Wafers  .     .     .  .261 
Marguerite   Wafers    .     .  320 
Toasted  Crackers  .     .     .  256 
Cranberry  Jelly     .    .    .  280 
Cranberry  Sauce    .     .     .  280 
Cream  Sauce 

Cream  Sauce  (Fish)  .  .  165 
.  "  "     (Macaroni)  .  245 

"  (Noodles)  .  246 
"  (Scalloped 

Dishes)  271 

Cream  Sauce  (Toast)      .  257 
"     (Vegetables)  271 
Cream  of  Tartar  Drink  .  114 
Cream  (Whipped)    .     .     .  305 

Croutons  230 

Crumbs  (Buttered)  .  .  .246 
Crust  Coffee  .  .  .  .126 
Cucumber  Relish  .  ,  .166 
Currant  Water  .    .    .  .115 

Custards 

Baked  Custards  .  .  .  288 
Baked  Custard  No.  Il'  .  289 
Baked  Caramel  Custard  .  290 
Chocolate  Custard  .  .  .  289 
Custard  Junket  .  .  .  294 
Custard  Souffle  ...  292 
Frozen  Custard  .  .311 
Malted  Milk  Custard  .  290 
Soft  Custards  ....  287 
V/hite   Custard     ...  289 


INDEX  TO  RECIPES 


451 


Z>. 

Dandelion  Greens 
Date  Bonbons  . 

"  Tapioca 
Desserts  (Frozen) 
Ice  Cream  . 
Caramel  Ice  Cream 

"        Ice  Cream  No 
Chocolate  Ice  Cream 
Coffee 

Frozen  Custard 
Grape  Ice  Cream  . 
Hot  Cocoa  Sauce  for 

Cream 
Junket  Ice  Cream  . 
Malted  Milk  Ice  Cream 
Peach 
Peptonoids 
Kaspberry 
Strawberry 
Vanilla 
Ices  . 
Clam  Frapp6 
Fruit   Ice  . 
Grape  Frapp^ 


PAGE 

.  269 
.  282 
.  301 
.  306 
.  306 
.  310 
II  310 
.  308 
.  308 
.  311 
.  309 


Orange  Bread  Pudding 
Plain  " 


302 
302 


Ice 


311 
308 
310 
309 
311 
309 
309 
307 
313 
315 
314 
315 


Lemon  Ice  314 

Orange  "  313 

"      "  No.  II    .     .     .  314 
"  No.  Ill  .     .     .  314 
Orange  Straws  .     .     .  .315 
Pineapple  Ice    .     .     .  .315 
Scalpicon  of  Fruit  .     .  .315 

Sherbet  312 

Clam  Sherbet   .     ...  312 
Grape  Ambrosia    .     .  .313 
Grape  Sherbet  .     .     .  .313 
Lemon  Milk  Sherbet   .     .  312 
"     No.  II  312 
Malted  Milk       "       .     .  313 
Strawberry         "       .     .  312 
Strawberry         "     No.  II  312 
Desserts  (Hot  and  Cold)  286 
Bread  Puddings     .     .     •  302 
Cheese     Bread  Pudding 

(Diabetic)  ....  304 
Chocolate  Bread  Pudding  303 
Gluten  Brown  Betty  .  .  304 
Jelly  Bread  Pudding  .  .  303 
Lemon    "  "       .     .  303 


Cornstarch 
Mange 
Cornstarch 
Cornstarch 


OR  Blanc 


295 
295 
295 
296 
297 
297 


Fruit  Jelly 
Pudding  . 
Gum  Gluten 
Irish  Moss  Blanc  Mange 

"     Jelly    .  . 
Malted  Milk  Blanc  Mange  296 
Nutritious  Wheat  Pudding  296 
Pineapple  Cream   .     .     .  295 
Cracker  Pudding  .     .     .  304 
Walnut,  Biscuit  Crisps   .  305 
Plain  Cracker  Pudding  .  304 
Custards 
Baked  Custards    .     .     .  288 
Baked  Caramel  Custard  .  290 
or  Cup         "        .  288 
"      Custard  No.  II   .  289 
Chocolate  Custard      .     .  289 
Malted  Milk    "  .     .  290 

Peptonoids       "  .     .  290 

White  "  .     .  289 

Soft  Custards  ....  287 
Almond  Pudding  ...  288 
Apple  Custard  ....  288 
Banana  "  ....  288 
Floating  Island     ...  288 

Meringue  287 

Orange  Custard     .     .     .  288 
Peach  Custard  ....  288 
Soft  Custard  No.  I     .     .  287 
"     Custard  No.  II   .     .  287 
"     Custard  (Diabetic)   .  287 

Junket  293 

Cocoa  Junket  .  .  .  .  294 
Coffee  "  ....  294 
Custard  "  ....  294 
Plain  "  ....  293 
Junket  Ice  Cream  .  .  308 
Pudding  Sauces  .  .  .  305 
Foamy  Sauce  ....  305 
Fruit  ....  306 

Hard  "  ....  305 
Orange  ....  210 

Whipped   Cream    .     .     .  305 
Whipped  Cream  No.  II  .  306 
Rice  Puddings  ....  297 


452 


INDEX  TO  RECIPES 


PAGE 

Boiled  Rice  297 

Cream  of  Rice  Pudding  .  299 
Peaches  and  Rice  .  .  .  298 
Plain  Rice  Pudding  .  .  299 
Rice  Meringue  ....  299 
Southern  Snow  Balls  .  .  298 
Steamed  Rice  ....  298 
Tapioca  Puddings  .  .  .  300 
Apple  Tapioca  ....  300 
Chocolate  Blanc  Mange  .  301 
Date  Tapioca  ....  301 
Pineapple  Tapioca  .  .  .  300 
Plain  "       ...  -300 

Raspberry      "       ...  301 
Tapioca  Cream  ....  300 
Whips  and  Souffles  .     .  290 
Custard   Souffle     .     .  .292 
Fruit  Whip      ....  291 
Grape  Whip     .     .     .  .291 
Lemon  Souffle  ....  292 
Omelet  Souffle  ....  292 
Peach  Meringue     .     .     .  293 
Strawberry  Whip  .     .  .291 
Dees  sing  for  Poultey  .     .  154 
"    Salads    .     .  272 
Dried  Fruit  Soup    .     .  .227 
Dry  Peptonoids  Soluble   .  492 
Peptonoids  Sandwiches    .  260 

E. 

Eggs  175 

Albuminized  Clam  Water  123 
"           Grape  Juice  123 
«           Milk      .     .  122 
^           Orange  .  .123 
Sherry    .     .  123 
«           Water    .     .  122 
Albumin  Water    (for  In- 
fants)  122 

Baked  Custard      ...  288 

Baked  Eggs  180 

"  Eggs  (Diabetic)  .  180 
Baked  Meat  Omelet  .  .182 
Beef  Egg-nog  ....  120 
Coddled  Eggs  (Scrambled)  183 
Coffee  Egg-nog  ....  120 
Egg  Broth  (Milk)      .  .118 


PAGE 

Egg  Broth  (Water)  .  .221 
"  Broth  (Beef)  .  .221 
"     Lemonade  ....  121 

"     Nests  181 

"  -nog  No.  I  .  .  .  .119 
"  -nog  No.  II  .  .  .119 
"     Sandwiches     .     .  .183 

"     Sauce  165 

"     Sauce  No.  II  .     .     .  166 
"     and  Brandy    .     .  .120 
"    Rum  ....  120 
"    Wine  ....  120 
"    Sherry  Gruel     .  241 

Filled  Eggs  184 

Golden  Rod  Egg  .  .  .181 
Grape  Juice  and  Egg  .     .  122 

Grape  Yolk  121 

Hard  Cooked  Egg  .     .  .180 
Junket  Egg-nog     .     .  .119 
Malted  Milk  and  Egg  .  .121 
Marguerite  Salad  .     .     .  275 
Mulled  Wine    ....  122 
Omelet  (Bread)      .     .  .182 
(Foamy)    ...  181 
"      (Meat)       ...  182 
Pineapple  Egg-nog     .  .120 
Poached  or  Dropped  Egg  .  182 
Egg  in  Milk  .     .  182 
Shirred  Egg     ....  183 
Eggs  No.  II  .  .183 
Soft  Cooked  Egg    .     .  .179 
"  No.  II  .  180 
"  Custard     ....  287 
Steamed  Eggs  ....  180 
Stokes'  Mixture     .     .  .121 
Water  Lily  Salad  ...  276 
Whips  and  Souffles   .     .  290 
Evaporated  Milk  .     .  193-194 

F. 

Farina  Gruel     ....  239 

Fish   159 

Baked  Fish   162 

Baked  Fish    (Diabetic)    .  164 
Broiled   Fish    ....  162 
Creamed  Cod  Fish      .     .  163 
Cod  Fish  (Dia- 
betic)   164 


WDEX  TO  RECIPES 


453 


PAGE 


Creamed  Fish  ....  163 
Fish  (Diabetic)  164 
Fish  (Diabetic)  .  .  .164 
Halibut  a  la  Creole  .  .163 
Scalloped  Fish  ....  163 

Fish  Sauces  165 

Butter  Cream  .  .  .  .165 
Cream  or  White  Sauce  .  165 
Cream  Sauce  (Diabetic)  .  165 
Cucumber  Relish   .     .  .166 

Egg  Sauce  165 

"     Sauce  No.  II      .     .  166 
Hollandaise  Sauce  .     .     .  166 
Tomato  Sauce  ....  166 
Flaxseed  Tea     .     .     .  .136 
Flaxseed  and  Licorice  Tea  136 
Floating  Island  ....  288 

Flour  Gruel  493 

Flour  Ball  242 

Frapp^ 

Clam  Frapp6  ....  315 
Grape     "        ....  315 

Frosting  320 

Frozen  Custard  .     .     .  .311 
Frozen  Desserts  (See  Des- 
serts)  306 

Fruits  276 

Apples  — Cuban  Style     .  280 
Baked     ...  279 
Stewed    ...  279 
"         and  Prunes  .     .  280 
Apricot  and  Prune  Sauce  280 
Baked  Banana  ....  280 
Cranberry  Sauce  or  Jelly  280 
Date  Bonbons  ....  282 
Figs,  Stewed     ....  282 
Lemon  Baked  ....  280 
Orange  Baked   ....  280 
No.  II  .     .     .     .  281 
Straws  .     .     .  .315 
"       Sunflower  ...  281 

Pineapple  281 

Prunes  Stewed  .  .  .  .281 
Rhubarb  Steamed  ...  282 

Fruit  Ice  314 

Fruit  Punch  .  .  .  .117 
Fruit  Pudding  Sauce  .  .  306 
Feuit  Salad  275 


PAGE 

Fruit  Sandwiches   .    .    .  259 

I'ruit  Soup  227 

Fruit  Whip  291 

Fruitade   .    .    .    .    .  .112 

G. 

Game  (Note  Poultry)  .    .  152 

Gelatin  495 

Bavarian  Cream    .     .  .210 

Coffee  Jelly  207 

Cream    "  207 

Grape  Fluff  211 

Grape  Jelly  206 

Jell-0  212 

Lemon  Jelly     ....  206 
Made  in  a  Minute  Dessert  212 
Orange  Baskets      .     .     .  206 
"     Charlotte    .     .  .211 
"     Jelly     ....  205 
"     Jelly  No.  II  .     .  206 
Panopepton  Jelly  .     .     .  208 
Panopepton     Jelly  with 

Orange  209 

Peach  Jelly  207 

Peptonoids  Coffee  Jelly    .  207 
Wine  Jelly     .  205 
Peptonised  Milk  Jelly     .  208 
Snow  Pudding  ....  209 
(Ind.)       .  209 
Spanish  Cream      .     .     .  210 
"     (Ind.)  .     .  210 
Strawberry  Mousse     .  .212 

Wine  Jelly  204 

"     No.  II  .     .     .  205 
Sauces:  Served  with  Gel- 
atin 

Orange  210 

Soft  Custard     ....  287 
Whipped  Cream     .     .     .  305 
Gems 

Cornmeal  Gems     .     .     .  254 
White  Gems     ....  254 
Ginger  Bread     ....  320 

Ginger  Tea  137 

Grape  Juice  (Welch's)     .  485 


Albuminized  Grape  Juice  123 
Grape  Ambrosia     .     ,  ,313 


454 


INDEX  TO  RECIPES 


PAGE  PAGE 

Grape  Frapp^  ....  315  Fish,  Baked      ....  164 

"      Fluff       .     .     .     .211          Creamed   164 

"     Jelly       ....  206  Creamed  Codfish  ...  164 

"      Ice  Cream   .     .     .  309  Gruel  or  Porridge  .     .     .  240 

"      Juice,  plain      .     .116        Muffins   253 

"      Juice  and  Egg  .     .  122         Noodles   246 

"     Lemonade    .     .     .121  Boiled  Noodles     .     .     .  246 

"      Lithia     .     .     .     .116  Noodles  Au  Gratin  .     .  246 

"      Nectar    ....  116  "       for  Soup     .     .  246 

"      Sherbet  ....  313  White  Sauce  ....  246 

"     Water     .     .     .     .115  Puddings 

"      Whip      .     .     .     ,291  Brown  Betty  ....  304 

"      Yolk       .     .     .     .121          Cheese   304 

Gravy  for  Roasts  .     .     .  152  Walnuts,  Gluten  Biscuit 

"       "    Roast  Poultry  155           Crisps   305 

Grouse,  Larded  .     .     .     .158          Plain   304 

Gruels                                238  Sauces 

Arrowroot  Gruel   .     .     .  238          Cream   246 

Barley  Gruel     ....  238          White   246 

"          "    with  Broth  .  238  Soups 

"          "    of  Jelly  .     .  238          Asparagus   224 

Browned  Flour  Gruel  .     .  242  Cream  of  Celery  .     .     .  225 

Caudle  241  "       "  Tomato      .     .  227 

Cracker  Gruel  ....  239          Oyster   172 

Egg  and  Sherry  Gruel   .  241  Toast 

Farina  Gruel    ....  239          French   258 

Flour  Gruel     ....  239  Wafers 

Flour  Ball                         242          Cheese   261 

Gum   Gluten  Gruel    .     .  240          Plain   261 

Indian  Meal  Gruel     .     .  240 

Oatmeal  Gruel  No.  I  .     .  240  n- 
"     No.  II      .  241 

"          "    No.  Ill    .  241  Halibut  a  la  Creole  .  .163 

Rice  or  Oat  Gruel  .     .     .  238     Ham  Broiled   152 

Rice  Jelly                          244     Hard  Sauce   305 

Tapioca  Jelly  ....  244  Hasty  Pudding  ....  242 

Gum    Gluten  —  How   Pro-           Herb  Tea   137 

CURED     ....  488-497  Hollandaise  Sauce  .     .     .  166 

Baked  Egg  180  Hominy  Mush    ....  243 

Biscuit                              252  Hot  Cocoa  Sauce    .     .  .311 

"     Crisps     ....  261  Hot  and  Cold  Desserts  .  286 

(a)  Drop  253 

(b)  Plain                          252  j 

Bread  252 

Breakfast  Food     .     .     .  242     Ice  Cream   307 

Cheese  Biscuit  Crisps  .     .  229  Caramel  Ice  Cream     .     .  310 

Crisps                                 256  "         «       a  jj 

Cakes  (Gluten  Nut)   .     .319  Chocolate  Ice  Cream  .     .  308 

Fish  164  Coffee  Ice  Cream  ...  308 


INDEX  TO  RECIPES 


455 


PAGE 

Frozen  Custard  .  .  .311 
Grape  Ice  Cream  .  .  .  309 
Hot  Cocoa  Sauce  for  Ice 

Cream  311 

Junket  Ice  Cream  .  .  .  308 
Malted  Milk  Ice  Cream  .310 
Peach  Ice  Cream  .  .  .  309 
Peptonoids  Ice  Cream  .  .311 
Raspberry  Ice  Cream  .  .  309 
Strawberry  Ice  Cream  .  309 
Vanilla  Ice  Cream  .     .     .  307 

Ices  313 

Clam  Frappe  ....  315 
Fruit  Ice  :  .  .  .  .314 
Grape  Frappe  .     .     .  .315 

Lemon  Ice  314 

Orange  Ice  313 

"  No.  II  .     .     .  314 
"  No.  Ill      .     .  314 
"      Straws  .     .     .  .315 
Pineapple  Ice   .     .     .  .315 
Scalpicon  of  Fruits    .  .315 

Indian  Meal  Gruel  .     .     .  240 

Irish  Moss 

Blanc  Mange    ....  297 

Jelly  297 

Lemonade  112 

J. 

Jellies 

Gelatin  Jellies  ....  203 
Jelly  and  Ice  .  .  .  .114 
Meat  Jellies  .  .  .  .221 
Starchy  Jellies  ....  244 

Jell-0   483 

Jell-0  with  Fruit  ...  212 
Made  in  a  Minute  Dessert  212 

Jelly  Bread  Pudding  .     .  303 

Junket     Tablets  (Han- 
son's)  480 

Junket 

Cocoa  Junket  ....  294 
Coffee  "  ....  294 
Custard  "  ....  294 
Junket  Egg-nog  .  .  .119 
Junket  Ice  Cream  .  .  .  308 
Plain  Junket  .  .  .  .199 
Whey  198 


PAGE 

KUMYSS 

Dr.  Brush's  Kumyss,  .  .198 
Home-made  Kumyss  .  .198 

L. 

Lamb 

Chops  Broiled  in  Paper  .  151 


French  Chops  ....  150 
Lamb       "    Broiled  .  .150 
Pan  Broiled  Chops     .  .150 
Lemon  Souffle  ....  292 
Lemonade 

Apollinaris  Lemonade  .  .111 
Bran  Lemonade  .  .  .111 
Effervescent  Lemonade  .  Ill 
Egg  "  .  121 

Fruit  "  .111 

Grape  "  .112 

Irish  Moss  "  .112 

Pineapple  "  .111 

Soda  "  .111 

Lemon    Baked    ....  280 
"       Bread  Pudding    .  303 

Ice  314 

"       Jelly     ....  206 
"       Milk  Sherbet  .  .312 
Whey    .     .     .  .198 
Liquid  Peptonoids   .     .     .  492 


Dry  Peptonoids  Soluble  .  492 
Dry  Peptonoids  with  Broth  218 
"  "         Sandwiches  260 

Liquid  Peptonoids  Cold    .  215 
Hot     .  215 
"  with  Whey  198 


Peptonoids  Coffee  Jelly    .  207  • 

Custard    .     .  290 

"         Ice  Cream     .  311 

Wine  Jelly    .  205 

Lettuce  Sandwiches    .     .  259 

Lime  Water   137 

M. 

Macaroni   245 

Baked  Macaroni   .     .    .  245 


456 


INDEX  TO  RECIPES 


Boiled  Macaroni 
Boiled  Noodles  . 
Noodles   ( Diabetic ) 
"       Au  Gratin 


PAGE 

245 
246 
246 
246 


Sauces  and  Accessories      .  245 
Buttered  Cracker  Crumbs  246 
Cream  or  White  Sauce  .  245 
"       Sauce     (Diabetic)  246 
Tomato  Sauce  ....  245 
Made  in  a  Minute  Dessert  212 
Maitre  D'Hotel  Butter  .  149 
Malted  Milk   (Horlick's)  487 
Malted  Milk    .     .     .  .194 
"         "    Blanc  Mange  296 
"        "    Cocoa     .  .134 
"         "    Coffee     .  .133 
"    Custard  .     .  290 
"         "    Ice  Cream    .  310 
"    Plain      .     .  194 
"    Sherbet  .     .  313 
"         "    and  Currant 

Jelly  114 

Malted  Milk  and  Egg      .  121 
"        "   with  Tamarind  116 
"  with  Wine     .  114 

Matzoon  199 

Meat    .     .     .     .     .     .     .  140 

Broiled  Bacon  ....  151 

Curled      "       ....  151 

Broiled  Ham    ....  152 

Broiled  Steak  ....  149 

Chops  or  Birds  Broiled  in 

Paper  151 

Lamb  Chops  Broiled  .  .  150 
French  Chops  ....  150 
Mutton  Chops  Broiled  .  150 
Pan  Broiled  Beef  Cakes  .  149 
Pan  Broiled  Chops  .  .  150 
Roast  Meats     .     .     .  .152 

Gravy  152 

Scraped  Beef  .  .  .  .217 
Meat  Jellies     .     .     .  .221 

Beef  Jelly  222 

Calfs  Foot  Jelly  .     .  .221 
Chicken  Jelly   ....  222 
Panopepton  Jelly  .     .     .  208 
with 

Orange  209 


PAGE 

Peptonoids  Coffee  Jelly  .  209 
"  Wine  Jelly    .  205 

Meat  Soups  (See  Broths)  217 

Meringue  287 

Rice  Meringue  ....  299 

Milk  184 

Albuminized  Milk  .  .122 
Baked  Milk  .  .  .  .194 
Brandy  and  Milk  .  .  .197 
Buttermilk  (Artificial)  .  199 
Cinnamon  and  Milk  .  .  197 
Condensed  Milk  .  .  .  192 
Evaporated  Milk  .  193-194 
Junket    ......  199 

Kumyss  198 

Milk  Toast  257 

Malted  Milk     ....  194 
Matzoon  or  Zoolak    .  .199 
Modified  Milk  ....  192 
Pasteurization  ....  193 
Peptonised  Milk    .     .     .  195 
Effervescent     ....  196 
By  the  Cold  Process      .  195 
"    "    Warm  Process  .  195 
Immediate  Process    .     .  196 
Partially  Peptonised      .  195 
Specially  "  .  196 


Rice  Milk  197 

Rum  and  Milk  ....  197 

Sherbets  312 

Sherry  and  Milk  ...  197 
Sterilization  .  .  .  .194 
Thickened  Milk      ...  239 

Whey  198 

Acid  Phosphate   .     .  .113 

Lemon  113 

Liquid  Peptonoids  with 

Whey  198 

Panopepton   with   Whey  198 
Wine  Whey    .     .     .  .113 
Minute  Tapioca  ....  484 
Miscellaneous    Beverages  127 
Cereal  Coffee   ....  133 
Cocoa  (Ind.)     ....  134 
Breakfast  Cocoa  .     .     .  133 
Malted  Milk  Cocoa  .     .  134 


INDEX  TO  RECIPES 


457 


PAGE 

Coffee  132 

Boiled  Coffee  ....  132 
(Ind.)  .  .  132 
Filtered  "  ....  132 
"  No.  II  .  .  133 
Malted  Milk  Coffee  .  .  133 
Perculator  Coffee      .  .131 

Chocolate  134 

Milk  Shake  .     .  135 
Syrup  ....  136 
Vienna  Style      .  135 
Plain  .     .     .  .134 
"          "     (Ind)    .     .  135 
Special  Non-Nutritive  Bev- 
erages  136 

Bran  Tea  137 

Cinnamon  Water  .  .136 
Flaxseed  Tea  ...  .  136 
Ginger  Tea     ...     .  137 

Herb  Tea  137 

Lime  Water   ....  137 

Slippery  Elm  Tea     .  .137 
Tea    ......     .  131 

Russian  Tea   .     .     .  .131 

Mock  Bisque  Soup  .     .     .  227 
Mousse,  Strawberry    .  .212 
Muffins 

Bran  Muffins    ....  254 

Gum  Gluten  Muffins  .     .  253 
Mulled  Wine     ....  122 

Mush      (  See  Breakfast 

Food)  242 

Mutton  Broth  .  .  .  .219 
Mutton  Chops  Broiled     .  150 

N. 

Noodles  (Diabetic)  .  .  246 
Au  Gratin  .  .  246 
Boiled   ....  246 

Non-Nutritious  Beverages  136 

Bran  Tea  137 

Cinnamon  Water  .  .  .  136 
Flaxseed  and  Licorice  Tea  136 
Flaxseed  Tea   .     .     .  .136 

Ginger  Tea  137 

Herb   Tea  137 

Lime  Water     ,    ,    ,  ,137 


PAGE 

Slippery  Elm  Tea  ...  137 
Nutritious  Desserts    .     .  286 
Nutritious    Wheat  Pud- 
ding  296 

Nuts  283 

0. 

Oatmeal 

Caudle  241 

Oat  or  Rice   Gruel    .     .  238 
Oatmeal  Gruel  ....  240 
"    No.  II  .     .  241 
"    No.  Ill      .  241 
"       Mush  ....  243 
"       Water      ...  125 
"     ■       "     No.  II      .  126 
Olive  Oil  (Nicelle)     .     .  489 

Salads  272 

Salad  Dressings  .  .  .  273 
Onions 

Boiled  269 

Oreamed  269 

Scalloped  269 

Soup  225 

Omelet 

Baked  Meat  Omelet  .  .  182 
Bread  Omelet  .  .  .  .182 
Foamy  Omelet  .  .  .  .181 
Meat  Omelet  .  .  .  .182 
Omelet  Souffle  ....  292 
Oranges 

Albuminized  Orange   .  .123 
Baked  Orange  ....  280 
Orange  Baskets      .     .     .  206 
"      Bread  Pudding    .  302 
"      Charlotte    .     .  .211 
"      Custard      ...  288 

"      Ice  313 

"    No.   II     .     .  314 
"    No.  Ill    .     .  314 
Jelly  No.  I     .     .  205 
"     No.   II    .     .  206 
"     Plain     .     .     .  .281 
"      Sauce    ....  210 
"      Straws  .     .     .  .315 
"      Sunflower  .     .  .281 
Orangeade  112 


458 


INDEX  TO  RECIPES 


PAGE  PAGE 

Oysters  166  Dry  Peptonoids  with  Broth  218 

Broiled  170  "          "        Sandwiches  260 

Creamed  170  Liquid    "         Cold    .     .  215 

Creamed  No.  II    .     .     .  170  "         Hot     .     .  215 

Pan  Roasted     ....  170  "         "        with  Whey  198 

Raw  169  Peptonoids  Coffee  Jelly  .  207 

Roasted  in  the  Shell  .     .  169  "         Custard  ...  290 

Scalloped  171  "         Ice  Cream   .     .  311 

Soup                                 171  "        Wine  Jelly  .     .  205 

Soup  (Diabetic)     .     .     .  172  Phosphate  (Horsford's)    .  478 

Stew  172  Acid  Phosphate     .     .  .113 

To  Wash  Oysters  .     .     .  169  "          "        Whey  .     .  113 

Pineapple  .  495 

Pineapple  Cream  .     .     .  295 
Egg-nog      .     .  120 
"  Ice    ...     .  315 

"         Juice     ...  113 

P.  "         Lemonade    .  .Ill 

Tapioca       .     .  300 

Panada    (Cracker)      .    .  126    Pop-Overs  254 

(Bread)     ...  127     Potatoes  .265 

Pan  Broiled  Beef  Cakes  149        Baked  266 

Ice  Panopepton      .     .     .  216        Boiled  265 

Panopepton  Bouillon  Hot  228        Creamed  267 

Hot    ...  216        Mashed  265 

"           Jelly  ...  208  Potatoes  Au  Gratin    .     .  267 

Jelly       with  Potato  Balls     .     .     .  .267 

Orange                            209  "      Cakes    ....  266 

Panopepton  with  Whey  .  198  "      in  Half  Shell  .     .  266 

Pasteurization   ....  193  Riced  Potatoes  ....  265 

Pasteurizer    (Hygeia)      .  194  Surprise  Balls  .     .     .     »,  266 

Parsley  Butter  .     .     .     .267     Poultry  152 

Peas  Green                          269  Birds  Broiled  in  Paper  .  151 

"     Canned                          270  Breaded  Sauce  for  Game  .  158 

"     Creamed  No.  1     .     .  270  Broiled  Chicken     .     .  .156 

No.  II  .     .  270  "       Quail  ....  15.6 

Peach  Ice  Cream    .     .     .  309  "       Small  Birds  .     .  156 

"      Jelly                           207  "       Squabs      ...  156 

"     Meringue       .     .     .  293  Creamed  Chicken  .     .  .157 

"      and  Rice  ....  298  Dry  Dressing  for  Stuffing  154 

Peptonised  Milk     .     .     .  195  General  Rule  for  Cleaning 

Effervescent      ....  196  Poultry  153 

By  the  Cold  Process  .     .195  Gravy  for  Roast  Poultry  .  155 

"    "    Warm  Process     .  195  Jellied  Chicken      .     .     .  157 

Immediate  Process     .     .  196  Larded  Grouse  ....  158 

Partially  Peptonised  .     .  195  "     Quail     ....  158 

Specially          "          .     .196  Roast  Poultry  ....  154 

Peptonoids  (Liquid)     .     .  492  Dry  Dressing  .     .     .  .154 

Dry  Peptonoids  Soluble    .  492  Gravy  155 


INDEX  TO  RECIPES 


459 


PAGE 

To  Bone  Birds  ....  155 
To  Clean  Poultry  ...  153 
To  Truss  "  ...  154 
Scalloped  Chicken  .  .  .  157 
Prunes  Stewed  .  .  .  .281 
Pudding  Sauces  ....  305 
Foamy  Sauce  ....  305 
Fruit  ....  306 

Hard        "       ....  305 
Orange      "       ....  210 
Whipped  Cream     .     .     .  305 
No.  II     .  306 

Punch 

Fruit  Punch  .  .  .  .117 
Tea  "  .  .  .  .  116 
Tutti  Frutti  Punch    .  .117 


Q. 

Quail 

Broiled  156 

Broiled  in  Paper  .  .  .  156 
Breaded  Sauce  for  Game  .  158 
Larded  Quail    .     .     .  .158 


R. 

Raspberry  Ice  Cream  .    .  300 
Tapioca  ...  301 
Rhubarb  Steamed  .     .     .  282 
Water  .     .     .  .115 

Rice 

Boiled  Rice  .  .  .  .  .297 
Cream  of  Rice  Pudding  .  299 
Peaches  and  Rice  .  .  .  298 
Plain  Rice  Pudding  .     .  299 

Rice  Gruel  238 

"     Jelly  244 

"     Meringue       .     .     .  299 

"     Milk  197 

"     Water      .     .     .  .125 
"     No.  II  .     .     .  125 
Southern  Snow  Balls  .     .  298 
Steamed  Rice   ....  298 
Roasts  of  Meats    ...  152 


PAGE 

Rum  and  Milk  •    ...  197 


/8f. 


Salads   

272 

Chicken  Salad  .... 

274 

Filled  Eggs      .     .     .  . 

184 

Fruit  Salad      .     .     .  . 

275 

Marguerite  Salad  . 

275 

Mixed            "      .     .  . 

275 

Sweetbread     "  ... 

275 

Tomato          "      .     .  . 

275 

Waldorf         "      .     .  . 

275 

Water  Lily  "... 

276 

Salad  Accompaniments 

276 

Cheese     Gluten  Biscuit 

Crisps  

276 

Cheese  Wafers  .... 

276 

Salad  Dressings 

272 

Boiled  Dressing 

273 

Cream  Dressing 

274 

French        "  ... 

273 

Mayonnaise  

273 

Sardine  Sandwiches 

260 

Sauces  for 

Ice  Cream  (Hot  Cocoa)  . 

311 

Macaroni  and  Noodles  245- 

-246 

Meat  

149 

Scalloped  Dishes  . 

271 

Fish  

165 

Pudding  

305 

Vegetable  

271 

Sandwiches  

258 

Boston  Brown  Bread  . 

259 

Bread  and  Butter  . 

259 

Cheese  Sandwiches 

259 

Chicken        "            .  . 

259 

Egg              "            .  . 

183 

Fruit            "            .  . 

259 

Lettuce  " 

259 

Nut              "            .  . 

259 

Peptonoids  " 

260 

Raw  Beef     "            .  . 

217 

Sardine         "            ,  . 

260 

Scalpicon  of  Fruits  . 

315 

Scraped  Beef  .... 

217 

Shell-Fish  

166 

166 

170 

460 


INDEX  TO  RECIPES 


PAGE 

170 
170 
170 
169 
169 
171 
171 
172 
172 
169 
172 

Albuminized  Clam  Water  123 


Creamed 

Creamed  No.  II  . 
Pan  Roasted  . 
Raw  .... 
Roasted  in  the  Shell 
Scalloped  . 
Soup  .... 
Soup  (Diabetic)  . 
Stew  .... 
To  Wash  Oysters 
Clams  .... 


Clam  Bouillon  . 

"     Bouillon  Bisque 
"     Broth      .  . 
"     Broth  No.  II 
"     Broth  on  Toast 
"  Frappe 
"     Sherbet  . 
"     Soup  .  . 
"     Stew  .  . 
"  Water 

"     No.  II 
Little  Neck  Clams 
Steamed  Clams 
Sherbet 

Clam  Sherbet  . 
Grape  Ambrosia 
Grape  Sherbet  . 
Lemon  Milk  Sherbet 

"  No, 
Malted  Milk  Sherbet 
Strawberry  Sherbet 

"  No, 
Sherry  (  Albuminized  ) 
Sherry  and  Milk 
Slippery  Elm  Tea 
Sippets 

Soda  Lemonade  . 
Soft  Custard 

Almond  Pudding 

Apple  Custard  . 

Banana  Custard 

Floating  Island 

Meringue 

Orange  Custard 

Peach  Custard  . 

Soft  Custard  No.  I 
«         No.  II 


174 
175 
173 
220 
25S 
315 
312 
174 
174 
173 
173 
172 
172 


.  312 
.  313 
.  313 
.  312 

II  312 
.  313 
.  312 

II  312 
.  123 
.  197 
.  137 
.  256 
.  Ill 
.  287 
.  288 
.  288 
.  288 
.  288 
.  287 
.  288 
.  288 
.  287 
.  287 


PAGE 

Soft  Custard  (Diabetic)  .  287 
Souffles  ob  Whips  .    .    .  290 

Soups  223 

Asparagus  Soup  (Cream)  223 
Soup    (Diabetic)  224 
Clam  Bouillon  .     .     .  .174 
"     Bouillon  Bisque     .  175 

"     Soup  174 

Consomme  228 

Cream  of  Asparagus   .     .  223 
"   Celery    ...  224 
"  Celery  (Dia- 
betic)  225 

Cream  of  Corn  .  .  .  224 
"  "  Onion  ...  225 
"Pea  ...  .  225 
"  "  Potatoes  .  .  226 
"  "  Rice  .  .  .  226 
"  "  Tomato  Soup 
(Diabetic)  ....  227 
Dried  Fruit  Soup  .     .     .  227 

Meat  Soup  217 

Mock  Bisque  Soup  .     .     .  227 
Onion  Soup   (Diabetic)    .  226 
Oyster  Soup     .     .     .  .171 
"  (Diabetic)     .  172 
"     Stew     .     .     .  .172 
Panopepton  Bouillon  .     .  228 
Tomato  Soup  with  Broth  226 
Victoria  Soup  ....  228 
Soup  Accompaniments  .     .  229 
Crisped  Crackers  .     .     .  229 

Croutons  230 

Gum  Gluten  Crisps    .     .  256 
"         "  Biscuit   Crisps  229 
"        "  Noodles     .     .  230 
Toasted  Crackers  .     .  .229 
Sponge  Cake     .    .  .318-319 

Special  Non-Nutritive  Bev- 
erages   136 

Bran  Tea   137 

Cinnamon  Water  .     .  .136 

Flaxseed  and  Licorice  Tea  136 

Tea      ...     .  136 

Ginger  Tea   137 

Herb  Tea   137 

Lim.e  Water      ....  137 

Slippery  Elm  Tea  ,     .     .  137 


INDEX  TO  RECIPES 


461 


PAGE  page; 

Spinach                              269  Date  Tapioca    ....  301 

Squabs,  Broiled  .     .     .     .156  Pineapple  Tapioca  .     .     .  300 

String  Beans     ....  270  Plain  Tapioca  ....  300 

Starchy  Beverages  .     .     .124  Raspberry  Tapioca     .     .  301 

Barley  Water  ....  124  Tapioca  Cream  ....  300 

"  for  Infants  .  125  Tapioca  Jelly    ....  244 

Bread  Panada  .     .     .     .127  Tea 

Cracker  Panada     ...  126        Bran  Tea  137 

Crust  Coffee     .     .     .     .126  Flaxseed  and  Licorice  Tea  136 

Oatmeal  Water      ...  125  "        Tea     ...     .  136 

"     No.  II  .     .  126        Ginger  Tea  137 

Rice  Water  125        Herb  Tea  137 

"    No.  II  .     .     .  125  Russian  Tea     .     .     .  .131 

Toast  Water     ....  126  Slippery  Elm  Tea  ...  137 

Starchy  Jellies     .     .     .  244        Tea  131 

Barley  Jelly     ....  244        Tea  Punch  116 

Cornstarch  Jellies  .     .     .  295     Toast  255 

Rice  Jelly                           244  Celery  Toast     ....  257 

Tapioca  Jelly    ....  244  Clam  Broth  Toast  ...  258 

Steak  (See  Beef)    ...  149  Cream  Toast    ....  257 

Sterilization  of  Milk     .  194  "        "    No.  II     .     .  257 

Sterilizer  (Hygeia)     .     .  194  Crisps  (Gum  Gluten)      .  256 

Steamed  Clams  .     .     .     .172  Croiitons      .....  230 

Stew,  Oyster     .     .     .     .172  French  Toast  (Diabetic)  .  258 

Stokes'  Mixture     .     .     .121  Gum  Gluten  Crisps   .     .  256 

Strawberry  Ice  Cream     .  309  "          "    Biscuit    Crisp  261 

"  Mousse       .     .  212        Milk  Toast  257 

"  Whip     ...  291         Sippets  256 

Sugar  Syrup  110  Toast  Crackers      .     .     .  256 

Sweet  Breads     ....  200  "     Sticks     ....  256 

Broiled  201  "     Water     ....  126 

Creamed  201  Water  Toast     ....  256 

"       No.  II     .     .     .  202  Tomato  Sauce  for  Fish  .  166 

Fricasseed                           202  "          "       (For  Maca- 

Parboiled  Sweet  Bread    .  201  roni  and  Noodles)   .     .  245 

Salad                                275  Tomatoes 

Sweet  Breads  with  Peas  .  202        Baked  270 

Sweetina                              488  Mock  Bisque  Soup     .     .  227 

Sypup  (Sugar)    .     .     .     .110        Scalloped  271 

Stewed  270 

Salad  275 

Soup  with  Broth   .     .     .  226 

T.  Turkey   (See  Poultry)     .  152 
TuTTi  Frutti  Punch    .  .117 

Tamarind  Water     .     .  .115 
Malted  Milk      .  116 

Tapioca  (Minute)   .     .     .  484  T. 
Apple  Tapioca  ....  300 

Chocolate  Blanc  Mange  .  301  Vanilla  Ice  Cream  ...  307 


463 


INDEX  TO  RECIPES 


PAGE 

Veal  Broth  .....  220 

Vegetables   261 

Asparagus  on  Toast  .     .  268 

Boiled   267 

Creamed   268 

Beet  Greens      ....  269 

Carrots   268 

Boiled   268 

Creamed   268 

Cauliflower   268 

Boiled   268 

Creamed   268 

Celery  .268 

Boiled   268 

Creamed   268 

Dandelion  Greens  .     .     .  269 

Onions   269 

Boiled   .     .     .     .     .  .269 

Creamed   269 

Scalloped   269 

Peas,  Green      ....  269 

Canned  ....  270 
"      Creamed  No.  I  .  .270 

No.  II      .  270 

Potatoes   265 

Baked   266 

Boiled   265 

Creamed   267 

Mashed   265 

Potato  Au  Gratin     .     .  267 

Balls   ....  267 

Cakes  ....  266 

Half  Shell     .     .  266 

Riced  Potatoes     .     .     .  265 

Surprise  Balls     .     .     .  266 

Spinach   269 

String  Beans    ....  270 

Tomatoes     .     .     .     .     .  270 

Baked   270 

Scalloped   271 

Stewed   270 

Vegetable  Sauces  .     .  .271 

Cream  or  White  Sauce  .  271 
Sauce  No.  II  .  .271 

Parsley  Butter  ....  267 


PAGE 

Victoria  Soup    ....  228 
W. 

Wafers 

Cheese  Wafers  ....  276 
Gluten  Cheese  Wafers  .  261 
Marguerite  Wafers     .     .  320 

Water    (Albuminized)      .  122 

Whey 

Acid  Phosphate     .     .  .113 

Lemon  113 

Liquid    Peptonoids  with 

Whey  .198 

Panopepton  with  Whey  .  198 
Wine  Whey      .     .     .  .113 
Whipped  Cream  ....  305 
Whips  and  Souffles  .    .  290 
Custard  Souffle  ....  292 

Fruit  Whip  291 

Grape  Whip  ....  291 
Lemon  Souffle  ....  292 
Omelet  Souffle  ....  292 
Peach  Meringue  .  .  .  293 
Strawberry  Whip  .  .  .291 
White  Sauce  for 


Fish   165 

Macaroni   245 

Noodles   246 

Scalloped  Dishes    .     .  .271 

Vegetables   271 

Wine  Jelly  No.  I  .     .     .  204 

"     No.  II  .     .     .  205 

(Mulled)    ....  122 

"      Whey   113 

Y. 

Yeast   249 


ZOOLAK  199 


GENERAL  INDEX 


CLEAN  SCALP- 
HEALTHY  HAIR 

The  important  detail  in  the  success- 
ful care  of  the  hair  is  scalp  cleanliness. 
Physicians  know  from  experience  that 
this  is  effectively  accomplished  by  system-- 
atic  shampooing  with 

PACKEK^S  TAPv  SOAP 

CAKE  or  LIQUID 

Made  from  selected  pine-tar,  glycerine 
and  sweet  vegetable  oils,  this  pure,  high- 
grade  soap  is  a  most  efficient  shampooing 
agent.  Used  systematically,  it  not  only 
removes  dust  and  dandruff  scales,  but  in 
addition,  so  increases  the  activity  of  the 
scalp  tissues,  that  the  health  of  the  hair  is 
materially  enhanced.  Almost  half  a  cen- 
tury of  hygienic  usefulness  that's  the 

record  of  "  Packer  s." 

yVe  have  just  issued  a  second  (revised 
and  enlarged)  edition  of  our  indexed 
manual  entitled :  "  The  Hair  and  Scalp- 
Modern  Care  and  Treatment."  If  you 
will  send  us  your  professional  card,  we 
will  forward  you  a  copy  together  with  a 
sample  of  Packer's  Tar  Soap  (cake  or 
liquid.) 

The  Packer  Mfg.  Co.,  Suite  86B, 

81-83  Fulton  St.,  New  York 

464 


GENERAL  INDEX 


A. 

Absorption   46 

"       of  Carbohydrates  48 

of  Fats     ...  48 

"      of  Mineral  Matter  49 

of  Protein      .     .  47 

of  Water  ...  49 

Absorption,  Summary  of     .  49 

Acid,  Hydrochloric  .     .  30,  37 


PAGE 

Appetite  of  the  Sick  .     .  .75 
Appetizers  (See  under  Bev- 
erages). 

Apples  278 

Asparagus  .  .  .  .  ,  .  265 
Assimilation  50 


Acidosis,  Dietetic  Treatment  357 
Acid  Phosphate    .     .     .  .113 

Acids,  Fatty  20 

Acids,  Vegetable  .     .     .  .31 

Salts  of  31 

Adolescent,  Diet  of  .  .  .  442 
Aged,  Diet  for  ...  .  443 
Albumin,  Cooking  of  .  .  11 
Effects  of  Heat  on  178 
Albuminoids    .     .     .  8-10-140 

Albumins  9-10 

Albuminuria,  Diet  in     .     .  394 
Alcohol,  in  Pneumonia  .     .  349 
"       Use  of  in  Sick  Poom  83 
"       Value  of  in  Tuber- 
culosis  352 

Alcoholics  as  Beverages  .     .  35 

Algje  284 

Amino  Acids  39 

Amylopsin  45 

Anabolism  50 

Animal  Food    (See  Protein, 

Meats,  Eggs,  Milk,  Etc.).  Beets 
Antiseptics  in  Food  Preser-  Beverages 

vation  95 

Appendicitis,  Diet  in    .     .  389 
Appetite  (See  under  Diges- 
tion). 


Baby's  Stomach,  Capacity  of  409 
Beans  ( See  Legumes ) . 
Beating  in  Cookery  . 
Beef  


90 
144 

Cuts  of  146 

Drippings      ....  20 

Extracts  214 

Juice  212 

213 
213 
212 
213 
213 
212 


"     "    Absorption  of  . 
"      "    Care  in  Serving 
"     "    Composition  of 
Beef  Juice,  Substitutes  for 
"    vs.  Beef  Tea  . 
"  Preparations 
"    Principles  of  Cooking  .  213 

"    Paw  214 

"Tea  213 

"    Composition  of     .  213 
"      "    Nutritive  Value  of  214 
"    vs.  Beef  Juice  .     .  213 


"  vs.  Broth 
Tests  for  Good 


465 


.  218 
.  144 

.  264 
35,  109 
Acid    .     .     .  .110 
"  Sweetening  of  110 
Albuminous    .  .118 
as  Appetizers     .  35 


466 


GENERAL  INDEX 


PAGE  PAGE 

Beverages,  Miscellaneous     .  127  Calcium  Phosphate   ...  29 

"        Nutritive  ...    35     Calories  57 

"        Sapid  ....    35     Calorimeter  57 

"         Stimulating   .     .    35     Cane  Sugar  14 

"         Thirst  Quenching    35  "       *'      Description  of  .  14 

Special    Non-Nu-  "       "      Food,  Uses  of  .  14 

tritive  136  "       "     Sources  of  .     .  14 

Beverages,  Starchy    .     .     .124  Carbohydrates      .     .     .  .12 

Digestion  of      ....  124  "          Absorption  of  48 

Principles  of  Cooking  ,     .  124  "  Classifications 

Bile  38  of  ...  13 

Biliousness,  Diet  in  .     .     .  395  "           Definition  of  12 

Body,  Composition  of     .    '.      4  "            Digestion   of  40 

"     Energy  Requirements  "            Function    of  12 

of  60  "of  Animal  Food  138 

Bottle  Feeding     ....  410  "            Source  of    .  12 

Bread,  Composition  of    .     .  247     Carbonates  30 

"      Digestibility  of  .     .  247     Carrots  264 

"      Energy  Value  of    .  256     Casein  9,  185 

"      Fermented     .     .     .249     Cauliflower  265 

Gluten      ....  248     Celery  265 

"      Making  of    .     .     .  249  Cellulose      ....    17,  235 

"      Nutritive  Value  of  .  247  Centigrade  Scale,  Change  to 

"      Puddings  ....  302  Fahrenheit     ....  106 

"      Toasted    ....  255  Cereal  Breakfast  Foods  .     .  235 

"      Unfermented       .     .  250     Cereals  233 

Breakfast  Foods     .     .  235,  242  "      Care  of    ...     .  237 

Breast  Feeding    ....  406  "      Composition  of  .     .  234 

Bright's  Disease,  Acute,  Diet  "      Digestibility  of      .  236 

Bright's    Disease,    Chronic,  "      Nutritive  Value  of  .  237 

Diet  in  391  "      Principles  of  Cook- 

Bromelin   278  ing  235 

Broncho-Pneumonia,  Diet  in  350     Cheese  189 

Broth  217  Chicken,  How  to  Select  .  .153 

"      Composition  of    .     .217  Children,  Feeding  Sick  .     .  438 

"     Energy  Value  of  .     .218     Chlorides  29 

"     Principles  of  Cooking  217     Chocolate  129 

"     vs.  Beef  Tea  ...  218  "       Compared  with  Tea 

Butter  189  and  CofTee     .     .     .  .130 

Butterine                                 20  Chocolate,  Nutritive  Value  of  130 

Buttermilk  190  "       Principles  of  Cook- 
ing of   130 

Chocolate,  Source  of  .     .  .129 

C  Cinnamon  34 

Clams  168 

Cabbage                                265  "     Varieties  of    .     .     .  168 

Cake  317  Cloves  .......  34 

"    General  Directions  for  Cocoa   129 

Making  317  Codliver  Oil    ....    .  20 


GENERAL  INDEX 


PAGE 


Coffee   128 

"     Effects  of  ...     .  128 
"      Sources  of  .     .     .  .128 
Colic,  Dietetic  Treatment  of, 

in  Children  ....  438 

Collagen  10,  140 

Condiments   33 

Classification  of     ...  33 

Constipation,  Diet  in     .     .  382 
"         in  Nurslings, 

Treatment  of      .     .     .  441 
Consumption   (See  Tubercu- 
losis). 

Convalescence,  Diet  in  .     .  332 
Cooking,    Blending  Ingredi- 
ents in   90 

Cooking,  Methods  of      .     .  88 

"       Objective  Points  in  88 

"       Principles  of     .     .  89 

Processes,  Objects  of  89 

Processes,  Principal  89 
"  Success  in  .  .  .88 
"       Suggestions  in 

Method  of  Working  in  .  90 

Crackers   260 

Cream  185,  189 

Curds   190 

Cutting  in  Cookery  ...  90 

D. 

Dessert,  Frozen    ....  306 

Desserts,  Nutritious  .     .     .  286 

Dextrin   40 

Dextrose   13 

"  Description  of  .  .  13 
"  Food  Uses  of  .  .14 
"       Sources  of   .     .  .14 

Diabetes,  Diet  in  .     .     .     .  355 

Chronic,  Diet  of  .  358 
Diabetic  Chart   (Joslin  and 

Goodall)   359 

Diabetic    Diet    of  Bellevue 

Hospital   356 

Diabetic  Diet  of  Massachu- 
setts General  Hospital  .  357 
Diabetic  Diet  of  Presbyterian 

Hospital,  N.  Y.  .     .     .  357 

Diarrhoea,  Diet  in     .     .     ,  385 


467 


PAGE 

Diet,  after  Laparotomy,  etc.  399 
"     Animal,  Disadvantages 

of  Exclusive  .  .  .  139 
Diet,  Bellevue  Hospital    .     .  328 

"     Broth  327 

"  Convalescent  .  .  .  323 
"     Diabetic,    of  Bellevue 

Hospital       ....  356 
Diet,  Diabetic,  of  Massachu- 
setts Hospital  .     .     .  357 

Diet,  Enteric  388 

"     Extra,  for  Typhoid,  in 
Presbyterian  Hospital, 

N.  Y  341 

Diet,  Farinaceous  .  .  324-5 
"     Fat  Free     ....  326 

"     Fish  327 

"     High   Caloric,   in  Ty- 
phoid  336 

Diet,  Hospital,  General  Type 

of  323 

Diet,  Hospital  Extra      .     .  327 
Diet,  Ideal       .....  233 
"     in  Acute  Bright's  Dis- 
ease  390 

Diet  in  Acute  Gastritis  .  373 
"  in  Acute  Gout  .  .  367 
"     in  A  c  u  t  e  Nephritis, 

Mass.  GenT  Hosp.  .  392 
Diet  in  Acute  Rheumatism.  368 
"  in  Adolescence  .  .  .  442 
"  in  Appendicitis  .  .  389 
"  in  Albuminuria  .  .  394 
"  in  Biliousness  .  .  .  395 
in  Broncho- Pneumonia  350 
"  in  Chronic  Diabetes  .  358 
"  in  Chronic  Gastritis  .  373 
"  in  Chronic  Gout  .  .  368 
"  in  Constipation  .  .  382 
"     in  Convalescence  from 

Fever  332 

Diet  in  Convalescence  from 

Typhoid       ....  339 
Diet  in  Diarrhoea      .     .     .  385 
"     in  Diphtheria    ...  347 
"     in  Disease    ....  331 
"     in  Diseases  of  the  Gen- 

ito  Urinary  System    .  390 


468 


GENERAL  INDEX 


PAGE 

Diet  in  Disorders  of  Nutri- 

tion  

355 

Diet 

in 

Dysentery    .     .  386" 

-387 

(( 

in 

P   P  ... 

OO  1 

a 

in 

Fevers 

ooi 

a 

in 

O  i  O 

(( 

m 

Hesirt  Disease 

Odd 

(( 

in 

lllltJCtlUub  J^liStJctotJo  . 

ooi 

(( 

in 

Intestinal  Diseases 

ooi 

(( 

in 

Lithemiaf 

OUT 

obi 

(( 

J-iVi-ll^  lll   XcllUU.  . 

({ 

in 

IMLumps 

ooU 

S( 

in 

Nervous  Disorders* 

OoD 

i( 

v/Uct5lLy  .... 

OTA 

i( 

in 

Old  Age  .... 

•±'±0 

(( 

in 

Oxaluria  .... 

o^D 

(C 

in 

Pneumonia  . 

(( 

in 

Pregnancy 

401 

(( 

in 

Quinsy  .... 

346 

(( 

in 

Skin  Diseases 

396 

in 

Surgical  Cases  . 

397 

it 

in 

the  Sedentary 

443 

u 

in 

Tonsilitis 

346 

(C 

in 

Tuberculosis  (e  s  p  e- 

cially  Pulmonary  Con- 
sumption)     .     .     .  .351 
Diet  in  Typhoid,  Late  Con- 
valescent   ( Presbyterian 
Hospital,  N.  Y.)      .     .  341 
Diet  in  Typhoid,  Summary  of  337 
"    in  Ulcer  of  the  Stomach  376 
"    in  Vomiting  of  Preg- 
nancy  402 

"  in  Whooping  Cough  .  351 
Diet,    Liberal,    in  Typhoid 

Fever  ....     336,  341 

Diet,  Light   323-4 

Liquid  Enteric  .  .  .  388 
"  Liquid,  in  Typhoid  335,  337 
"    Meat,  Exclusive      .     .  51 

"    Milk  324 

"    Mixed  7 

"    Nephritic      ....  392 
Nitrogenous  ....  325 

"    Nutrient  325 

"    of  Nursing  Mother     .  404 
"    of  Wet  Nurse  ...  404 
Diets,  Presbyterian  Hospital, 

N.  Y  329 


PAGB 


Diet,  Restricted     ....  328 
"    Salt-free       ....  393 

"    Schmidt  327 

"  Special  Enteric  .  .  .  388 
"  Starvation,  in  Typhoid  334 
"  Vegetable  vs.  Animal  .  233 
"    Strictly  Sugar-free  .     .  357 

Test  326 

Dietaries   for   Young  Chil- 
dren  436 

Dietaries,  Hospital    .     .     .  323 

Digestion  36 

"       Evidences    of  in 

Sick  74 

Digestion  of  Fat  ....  40 
"        of  Protein,  Prod- 
ucts of     ....  37,  39 
Digestion  of  Protein,  Sum- 
mary of  39 

Digestion  of  Proteins     .     .  36 
"      of  Proteins  in  In- 
testines  38 

Digestion    of    Proteins  in 

Stomach  36 

Digestion  of  Starch    ...  40 
Products  of      ....  41 
Summary  of     ....  41 
Digestion  of  Sugars  ...  42 

Products  of  42 

Summary  of     ....  42 
Digestion,  Salivary    .     .  .41 
Rate  of     ...  45 
"        Resume  of     .     .  43 
Diphtheria,  Diet  in  .     .     .  347 
Disease,  Acute,  Feeding  in  .  73 
Diet  in  .     .     .  .331 
Disinfection  of  Utensils  .     .  84 

Drinks,  Cold  109 

Drinks,  Hot  10^ 

Dysentery    ( Acute  Colitis ) , 

Diet  in  387 

Dyspepsia;  Diet  in    .     .  .381 

E. 

Eggs  175 

"  Composition  of  .  .  ,175 
«    Cooking  of  .     .     .  11-12 


GENERAL  INDEX 


469 


PAGE 

Eggs,  Digestibility  of  .  .176 
"  Energy  Value  of  118,  179 
Nutritive  Value  of  .  .  177 
Principles  for  Cooking  178 
Suggestions  Concerning  178 
Test  for  Fresh  .  .  .178 
Varieties  of  .     .     .     .  176 

Enteric  Diet  388 

Equivalents,  Table  of  Metric  101 

Erepsin  39 

Excretion  .  ....  53 
Extractives,  Nitrogenous  11,  138 

144 

Extracts,  Flavoring  ...  34 


Fahrenheit  Scale,  Change  to 

Centigrade     ....  106 

Fat  19 

"   Absorption  of     ...  48 

"  Animal  138 

"  Cheap  Forms  of  .  .  .21 
"  Definition  of  .  .  .  .  19 
"  Description  of  ...  20 
"  Digestibility  of  ...  22 
"  Digestion  of  .  .  .  .40 
"  Function  of  ....  21 
"  Percentages  in  Cream, 
Table  Showing  ...  426 
Fat,  Principles  of  Cooking  .  22 
"  Sources  of  ....  21 
«  Tests  for  ....  23 
"     vs.     Carbohydrate  as 

Food  23 

Fat,  Value  of  in  Tuberculosis  352 
Feeding,  Details  of  .     .     .  76 
Forced    ....  78 
"        in  Acute  Disease  .  73 
Feeding,  Infant    ....  406 
Artificial     ...  406 
"        Breast    ....  406 
"        Hygiene  of  Natural  408 
Feeding,  Nasal     .     .     .     .  79 
Feeding  of  Young  Children  .  434 
"        of  Young  Children, 
General  Rules  for    .     .  435 
Rectal    ....  79 
"        the    Helpless  Pa- 
tient  78 


PAGE 

Feeding  the  Sick     ...  72 
the     Sick,  Physi- 
cians' Directions  for     .  72 
Feeding  the  Sick,  Position  in  77 
the  Sick,  Time  for  .  77 
"       the  Unconscious  Pa- 
tient  78 

Feeding  and  Sleep     ...  78 
Fever,  Diet  in      ....  331 
"     Typhoid  (See  Typhoid 
Fever). 

Fibrin  10 

F 
F 


sh 


278 
159 
160 
159 
161 
160 


Composition  of  . 
Digestibility  of 
Energy  Value  of  . 
Nutritive  Value  of 
Principles  of    Cooking  161 

Salt  160 

Sauces  165 

Season  for  .     .     .  .161 
Test  for  Freshness  of  161 
Fletcher,  Mr.,  on  Mastication  41 
Folding  In,  in  Cookery  .     .  90 
Food  Accessories   .     .     .    4,  33 
"    Adjuncts     .     .     .    4,  33 
"     Adulteration  of     .     .  97 
"     Animal  .     .     .     .  .138 
"     Animal,  Carbohydrates 

of  138 

Food,  Animal,  Composition 

of  138 

Food,  Animal,  Digestibility 

of   .  139 

Food,  Extractives  of  .  .138 
"  Mineral  Matter  of  .139 
"  Animal,  Proteins  .  .  138 
"  Animal,  Water  of  .  139 
"  Care  of  ....  92 
"     Care   of,   in  Markets 

and  Kitchens  ...  92 
Food,  Classification  of  .  5,  6 
Composition  of  .  .  4 
Concentration  of  .  .95 
Definition  of  .  .  .  4 
Effects  of  Heat  on  .  88 
Determination  of  Energy 
Value  of    ....  58 


470 


GENERAL  INDEX 


PAGE 

Food,  Fly  Pollution  of  .  .94 
"     How  to  Serve   .     .     .  8G 
"     Methods  of  Cooking  .  88 
"     Liquid   (Fluid)     .     .  323 
"     Nitrogenous      ...  8 
Classification  of     .  8 
Source  of    .     .     .  9 
Food,  Non-Nitrogenous   .     .  12 
"     Object  of    ...     .  3 
"     Predigestion  of     .     .  96 
*'     Preservation     ...  95 
"     Preservation  by  anti- 
septics  95 

Food  Preservation  by  D  r  y- 

ing  95 

Food  Preservation  by  Exclu- 
sion of  Air      ...  95 
Food  Preservation  by  Freez- 
ing  95 

Food,  Quantity  and  Quality 

of,  for  Sick  ...  76 
Food,  Soft  (Semi-Solid)      .  323 

"     Solid  323 

"  Source  of  ...  .  4 
"  Storage  of  ....  93 
"     Temperature    of,  for 

Sick  76 

Food  Values  54 

"     Values,  Tabulation  of  64-71 
"     Vegetable    ....  231 
"     Vegetable,  Carbohy- 
drates of    .     .     .  .232 
Food,  Vegetable  Composition 

of  31 

Food,  Vegetable^  Digestibil- 
ity of     . '   .     .     .     .  232 
Food,  Vegetable,  Fats  of    .  232 
"     Vegetable,  Mineral 

Matter  of    ....  232 
Food,  Vegetable,  Protein  of  .  232 
"     Vegetable,  Water  of  .  232 
"     Washing  of  Uncooked  93 
Formulae  for  Infant  Feeding  416 
Fowl,  How  to  Select   .  .153 
Freezing,  General  "Rules  for  307 
"         in  Small  Amounts  307 

Fruits  276 

"  as  Ballast  ...  279 
"      Composition  of    .  .276 


PAGE 

Fruits,  Digestibility  of  .     .  277 

Dried  279 

"       Flavoring  Principle  of  277 
"       (Fresh)  and  Vegeta- 
bles, Agreement  between  278 

Fruits,  Fuel  Value  of  .  .  278 
"  Nutritive  Value  of  .  278 
"  Precautions  in  Use  of  279 
"      Sugar-content  of  .     .  277 

Fungi  284 

G. 

Galactose   42 

Game  (See  Poultry). 

Gastric  Juice   37 

Gastritis,  Acute,  Diet  in     .  373 

Chronic,  Diet  in  .  373 

Gavage   439 

Gelatin  10,  203 

Digestibility  of  .     .  203 

"  Nutritive  Value  of  .  203 
"      Source  of  .     .     .  .203 

"     Principles  of  Cooking  203 

Gelatinoids     .     .     .    8-10,  140 

Ginger   33 

Glucose  (See  Dextrose). 

Gluten  Bread   248 

Standards      ...  249 

Gout,  Acute,  Diet  in      .     .  367 

Chronic,  Diet  in  .     .  368 
Grape  Sugar  (See  Dextrose). 

Grapes   278 

Gruels                            236,  238 

Gums   18 

H. 

Heat,  Average  Normal  Out- 
put from  Body  ...  62 
Heart  Disease,  Diet  in  .     .  396 
Helpless,  Feeding  the     .     .  78 

Horse-radish   33 

Hospital  Dietaries     .     .     .  323 


Ice  Box  and  Contents  .  .  91 
Ice  Cream  307 


GENERAL  INDEX 


PAGE  PAGE 

Ice,  Keeping  of,  in  Sick  Room    83     Levulose  43 

Ices  313     Lichens  284 

Infant  Feeding     ....  406  Lime  Starvation  ....  32 

Artificial    .  410     Lipase  40 

"       Caloric  Val-  Lithemia,  Diet  in     .     .    .  367 

ues  of                            429  Lying- In  Period,  Diet  in  .  403 

Infant  Feeding,  Formulae  for  416 
"  "       Hygiene  of 

Natural                         408  ^• 

Infant     Feeding,  Maynard 

Ladd  Table  for  .     .     .  425     Macaroni  235 

Infant  Feeding,  Scheme  of  Magnesium  29 

at    Lying-in    Hospital,  "          Phosphate    .     .  29 

N.  Y  431     Maltase  40 

Infant  Feeding,  Table  Show-  Maltose  40 

ing     Proportions      for  Marasmus  in  Infants,  Die- 
Healthy  Child    .     .     .427  tetic  Treatment  of  .     .  441 

Intestinal  Diseases,  Diet  in  .  381     Mastication  41 

Iron  29     Matzoon  192 

Measures  98 

"  Apothecaries'  .  .  100 
"         Approximate    .     .  100 

Jellies,  Starchy    ....  244  "         of  Volume,  Metric 

Juice,  Gastric  38  System  101 

"      Intestinal   ....    38  Measures  of  Weight,  Metric 

"     Pancreatic  ....    38  System  101 

Junket                            190,  293  Measures,  Table  of  .     .  .99 

Measuring  Cup,  Standard  .  98 

S:,  Meat  140 

"    Absorption  of  .     .     .  141 

Katabolism  50  "    Broiling  of  .     .     .  .142 

Kefir  192  "    Composition  of  .     .     .  140 

Kumyss  191  "    Cooking  .     .     .     .     w  142 

"    Cuts  of    .     .     .     143,  146 

L.  "    Digestibility  of     .     .  141 
"    Effect  of  Cooking  .     .  141 

Lactalbumin  185  "    Effects  of  Water  on  .  143 

Lactase                           42,  186  "    Energy  Value  of  .     .  149 

Lactose  14,  185  "    Jellies  .     .    204,  218,  221 

Lamb  145  "    Nutritive  Value  of      .  140 

"      Cuts  of      ....  148  "    Quality  of  ....  143 

"     Test  for  Good  ...  145  Uncooked     ....  141 

Laparotomy,  Diet  after  .     .  399  Metabolism  of  Carbohydrates  52 

Lecithin  20  "         "  Fat     ...  52 

Legumes                                262  "         "  Protein     .  .51 

"       Composition  of  .     .  262  Metric  System     ....  101 

"       Digestibility  of      .  263  Milk  as  a  Beverage    .     .     .  35 

"       Principles  of  Cook-  Ash  of    .     .     .     185,  186 

ing   263        "    Care  of  187 


473 


GENERAL  INDEX, 


PAGE 

Milk,  Certification  of     .    .  187 
"    Composition  of  .     .     .  184 
"    Condensed    ....  192 
"    Difference  Between  Hu- 
man and  Cows   .     .     .  410 
Milk,  Digestibility  of     .     .  185 
"     Energy  Value  of  .     .  193 
"     Evaporated       ...  194 
Evaporated      .     .     .  193 
"     Fats  of  .     .     .     185,  186 
(See  Cream,  Butter.) 
Milk,  Fermented  .     .     .  -.191 
"    Formulae,  Fat  to  Pro- 
tein =3:1      ....  419 
Milk,  Formulae,  Fat  to  Pro- 
tein =2:1      ....  422 
Milk,  Formulae,  Fat  to  Pro- 
tein, nearly  Equal  .     .  423 
Milk,  Home  Modification  of  414 
"     Human,  Drugs  in  .     .  405 
"     Laboratory       .     .  .414 
Metschnikoff's  Arti- 
ficially Soured  Milk     .  191 
Milk  Modification      ...  412 
"    Modification,  What  Di- 
lution to  Use    .     .  .413 
Milk,  Modified     ....  192 
"    Mothers,  Composition 


of  407 

Milk,  Nutritive  Value  of  .  185 
"  Pasteurisation  of  .  .  188 
"  Peptonized  .  .  .  .192 
"  Products  ....  189 
"  Quantity  to  Use  in  In- 
fant Feeding  .  .  .413 
Milk,  Skimmed    .     .     .  .186 

"     Sour  190 

Sterilisation  of     .     .  188 


Milk,  Sugar  (See  Lactose). 
Mineral  Matter    ....  29 

"    Absorption  of  49 
"  "    Amount  and 

Kind  of  in  Body    .     .  29 
Mineral  Matter,  Function  of  29 
"  "  Importance 

of  .......  31 

Mineral  Matter  in  Plants  .  31 
"            "     in  Animal 
Food  30,  139 


PAGE 

Mineral  Matter,  Source  of  .  30 
"    Uses    of  in 

Disease  32 

Moss,  Iceland  285 

"     Irish  285 

Mouth,  Cleansing  of,  before 

Feeding  77 

Mumps,  Diet  in  ...     .  350 

Mushrooms  284 

Mustard  34 

Mutton   145 

"      Cuts  of    ....  148 
"     Test  for  Good    .     .  145 
Myosin  10,  140 


Nasal  Feeding  ....  79 
Nephritic  Diet  ....  392 
Nervous  Disorders,  Diet  in  .  395 
Nitrogen  Balance  ...  54 
Nursing  Bottle  .  .  .  .415 
"  Mother,  Diet  of  .  404 
"       Schedule  for     .     .  409 

Nut  Butters  283 

"    Flours  283 

Nutmeg  34 

Nutrition  36 

"       Conditions  for  Per- 
fect  7 

Nutrition,  Diet  in  Disorders 

of  355 

Nuts  283 

"  Composition  of  .  .  283 
"  Cooking  of  .  .  .  .283 
"  Digestibility  of  .  .  284 
"    Nutritive  Value  of     .  284 

0. 

Obesity,  Diet  in  ...     .  370 

Oils    19 

Volatile   21 

Olein   20 

Oranges   277 

Oleomargarin   20 

Onions   264 

Ovariotomy,  Diet  after  .     .  399 

Oysters   166 


GENERAL  INDEX  473 

PAGE  PAGE 

Oysters,  Composition  of      .  167  Protein,  Digestion,  Table  of  39 

"     Digestibility  of  .     .  167  "       Function  of      .     .  10 

"      Energy  Value  of     .  169  "       Vegetable     ...  10 

"     Principles  for  Cook-  Proteoses  39 

ing  167     Prunes  278 

Oysters,  Season  for   .     .     .167  Ptomaine  Poisoning  ...  93 

Variety  of  .     .     .168     Ptyalin  40 

Puddings,  Bread  ....  302 

p  Punctuality      in  Serving 

Meals  75 

Palmitin  20     Purins  11 

Pancreatic  Juice  ....  38 

Parsnips   264 

Pasteurisation      .     .     .  .193 

"  Apparatus  for  194     Quinsy,  Diet  346 

Peas  (See  Legumes). 

Pectin  Bodies                         277  R, 

Pepper  34 

Pepsin  37     Radishes  264 

Action  of  ...     .           37  Rectal  Feeding     .     .     .  79-83 

Peptogenic  Milk  Powder  in  "      Formulae     for  82 

Infant  Feeding  ...  433  "         "      Technique    of  81 

Peptones                          37,    39  Reflex,  Pharyngeal    ...  41 

Percentage  Solutions,  Tables  "      Pyloric     ....  38 

for  Preparing     .     .     .  104     Rennin  37 

Phosphorus     .     .     .     .  20,    29  Rheumatism,  Acute,  Diet  in  368 

Physicians'    Directions    for  "          Chronic,  Diet  in  370 

Feeding  the  Sick     .     .    72  "          Diet  in  .     .     .  370 

Pineapples                             278  Rickets  in  Infants,  Dietetic 

Pneumonia,  Alcohol  in     .      349  Treatment  of     .     .  .441 

"         Diet  in    .     .    348      Roots  263 

Polysaccharides    .     .     .  16-19 

Pork  145 

Potassium  29 

Potatoes   264     Saccharin  15 

"       Energy  Value  of  .  265  Salad  Dressings   ....  272 

Poultry  152      Salads  272 

Digestibility  of      .  152      Salsify   264 

General     Rule     of  Salt  (See  Sodium  Chloride)  34 

Cleaning  153     Sandwiches  258 

Poultry,  Principles  of  Cook-  Sauces  33 

ing      ......  153  Salt  Starvation   ....  32 

Pregnancy,  Diet  in  .     .     .401  Scurvy,    Infantile,  Dietetic 

Prematurity,  Feeding  in     .  440  Treatment  of     .     .     .  441 

Protein,  Absorption  of   .     .47  Seasickness,  Dietetics  of     .  402 

"       Acid  ......    38  Sedentary,  Diet  of    .     .     .  443 

Alkaline      ...    39      Shell-Fish  166 

"       Animal    ....  138      Sherbets  312 

"       Cooking  of  .     .    .    11  Sick,  Feeding  the    .    ,    ,  72 


GENERAL  INDEX 


PAGE 

Skin  Diseases,  Diet  in  .     .  396 

Sodium  29 

Sodium  Chloride  ....  30 
"           "      as  a  Condi- 
ment  34 

Soup  223 

"  Accompaniments  .  .  229 
"    General      Rule  for 

Blending  223 

Spices  34 

Spinach  2^5 

Starch  .-1^ 

"      Cooking  of    .     .  .18 
"     Description  of    .     .  17 
^    "     Digestion  of  .     .  .40 
"     Food  Uses  of     .     .  17 
"      Source  of      ...  17 
Test  for   ....  19 
Starvation  Diet    ....  334 
Steak,  Broiled      ....  149 
Steapsin  (See  Lipase) 

Stearin  20 

Sterilisation  194 

Stirring  in  Cookery  ...  90 

Stomach  36 

"       Fundus  of   .     .  .37 
«       Pyloric  Sphincter  of  38 
Tube,  Use  of   .  .79 

Strontium  32 

Sucrase  42 

Sugar  13 

"  Dietetic  Uses  of  .  .  15 
"     Digestion  of   .     .  .42 

"      Invert  277 

"     of    Milk    (See  Lac- 
tose). 

Sugar  Starvation  ....  357 
"  Substitutes  for  .  .  15 
"  Tests  for  ....  16 
"     Use  of  in  Cookery  .  15 

Sulphur  29 

Surgical      Cases,  Dietetic 

Management  of  .     .     .  397 

Sweetbreads  200 

Definition  of     .  200 
Digestibility    of  200 
"         Energy  Value  of  201 

Sweetina  15,  110 

Syntonin    ......  1^ 


PAGE 

T. 

Tallow  20 

Tea  ]27 

Active  Principles  of  .127 
"    Effects  of      ....  128 

Thermometry  106 

Top  Milk  Method     .     .  .416 

Toast  255 

Tubers  (See  Roots)  .  .  .  263 
Tuberculosis,  Diet  in  .  .351 
Turnips  264 


U. 


Ulcer,  Gastric,  Diet  in  .  .376 

Massachusetts  Genl 

Hospital  379 

Unconscious,  Feeding  the  .  78 
Uric     Acid     Excess  (See 

Lithsemia ) . 
Utensils,  Disinfection  of     .  84 

V. 

Veal  144 

"    Test  for  Good  ...  145 
Vegetables  .     .     .     .     .  .261 

Digestibility  of  .  262 
"         Composition  of  .  26l 
"         Green  ....  265 

"        Principles  of 

Cooking  262 

Vegetable  Sauces      .     .  .271 

Vinegar  34 

Viscera,  Animal,  Food  Uses 

of  144 

Vomiting,  Diet  in     .     .     .  402 
"         in    Young  Chil- 
dren, Dietetic  Treatment 
of  438 

W. 

Wafers  260 

Water  23 


GENERAL  INDEX 


475 


Water,  Absorption  of  , 

AQ 

Wafov  Wnll 

ZD 

it 

Alkflline   .     •  « 

<c 

jjuiicu.         .      •  • 

Weight  Development  of  In- 

C( 

"rKnn  ci  'fori 

fant,  Computation  of  . 

A  on 

(( 

ZD 

OQ 

yo 

i( 

Composition  of 

OQ 
Zo 

laoie  01  ... 

on 

<{ 

UlfeLllltJU.  ... 

Z/ 

**       Apothecaries  « 

lUU 

(( 

Drinking  ,     .  , 

W^et  Nurse      .     .     •     «  . 

ACM 

« 

on 
ZO 

JJiet  01     .     ,  . 

4U4: 

J;  UUU.        oco    Ul  • 

25 

190 

« 

Functions  of  . 

Ci  A 

Whey-made  Formulae 

AO  A 

(( 

Hard  .... 

OK 

Whey  Mixtures,  Method  for 

(» 

in  Animal  Food  . 

139 

Calculating 

428 

(6 

Properties  of 

!  23 

Whooping  Cough,  Diet  in  . 

351 

C( 

Rain  .... 

26 

it 

Soft  .... 

25 

(C 

Sources  of 

.  24 

Z. 

(( 

Spring 

.  26 

t( 

Temperature  of  . 

.  28 

19 

INDEX  TO 

PURE  FOODS  —  SUPPLIES  FOPt  THE  DIET- 
KITCHEN  —  SUPPLIES  FOR  THE 
SICK-ROOM 

"  Good  nutrition  depends  upon  pure  and  healthful  food." 

There  is  no  subject  which  should  more  engross  attention 
than  the  purity  of  the  preparations  that  are  used  in  the  va- 
rious compounds  for  the  human  stomach,  and  in  the  sick- 
room. 

A.  F.  P. 


It  is  delicious,  pure  and  healthful 

Baker's 
Breakfast 
Cocoa 

EXCELS  IN  ALL  THE 
ESSENTIALS  OF  A 
GOOD  COCOA 

\T  has  the  delicious  natural 
flavor  of  the  best  cocoa  beans, 
scientifically    blended,  unim- 
paired by  the  addition  of  any 
foreign  flavoring  substances. 
Its  purity  is  unquestioned, 
samples  purchased  in  the 

EegisteredU.S.'^t.  Office    ""P^"^   market    serving  as 

standards  for  chemical  re- 
search. It  is  healthful,  supplying  the  body  with  some 
of  the  purest  elements  of  nutrition  in  a  most  agreeable 
form.  These  qualities  combine  to  make  it  the  ideal 
food  beverage. 

53  HIGHEST  AWARDS  IN  EUROPE  AND  AMERICA 

Be  sure  you  get  the  Genuine  witb  the  Trade-Mark  on  the  package.  Booklet 
of  Choice  Recipes  Sent  Free. 

WALTER  BAKER  &  CO.  LTD. 
Established  1780        DORCHESTER,  MASS. 


477 


A  Nourishing  and  Cooling 
Drinii  for  tlie  Skk 

In  convalescence,  for  weakness,  nervousness 
or  feverish  conditions,  Horsford's  Acid  Phos- 
phate is  safer,  more  palatable  and  more  bene- 
ficial than  lemonade  or  lime  juice. 

HORSFORD'S 

Acid  Phosphate 

contains  valuable  nutrients — phosphates  of  calci- 
um, sodium,  magnesium  and  iron.  It  is,  there- 
fore, far  superior  to  Dilute  Phosphoric  or  other 
acids. 

It  is  recommended  especially  for  promoting 
digestion,  strengthening  the  nervous  system  and 
in  wasting  diseases. 

A  teaspoonful  in  a  glass  of  cold  water  makes 
a  most  grateful  beverage. 

Nurses  and  Physicians  please  write  for 
Free  Samples. 

RUMFORD  CHEMICAL  WORKS  Providence,  R,  I. 


478 


fellows'  Syrup 


of  the 


Hypophosphites 


Brilliant  results  are 
obtained  from  the 
administration  of 
this  long-tried  and 
standard  preparation 

TRY  IT! 


1>0'0  /^-^Cheap  and  Inefficient  Substitutes 
'     ^^Preparations  "  Just  as  Good  '* 

Samples  sent  upon  request  to 

The  Fellows  Medical  Manf g*  Co.^  Ltd. 

26  Christopher  Street,  New  York 


479 


JUNKET 

The  Perfect  Milk  Food 

JUNKET  TABLETS  contain  absolutely  nothing  but  the 
pure  Rennet  Ferment  and  a  little  pure  table  salt.  No  chemi- 
cals whatever  enter  into, their  manufacture. 

Ideal  for  the  preparation  of  WHEY,  MODIFIED  or  HUMANIZED 
MILK,  JUNKET  PUDDINGS  and  ICE  CREAM  in  endless  variety. 
10  Tablets  for  10  quarts,  10c.     100  Tablets  in  a  package,  75c. 


Junket  Brand  Buttermilk  Tablets 

Compressed  Lactic   Ferment  Culture  prepared  at  the  Bacteriological  de- 
partment of  Chr.  Hansen's  Laboratory,  Copenhagen,  Denmark. 
Converts  sugar  of  milk  into  lactic  acid,  rendering  the  milk  palatable  and 
healthful,  and  a  preventive  and  curative  for  many  intestinal  disorders. 
15  Tablets  in  a  vial,  25c,  75  Tablets  in  a  package,  $1.00 

At  all  druggists,  or  by  mail  direct  from  the  manufacturers 

CHR.   HANSEN'S  LABORATORY 

Box  1709  LITTLE  FALLS,  N.  Y. 


480 


0.  I^ll  0. 


N.  B.  C.  Food  Products 
Suitable  for  Diet 

National  Biscuit  Company  bakes  a  great 
variety  of  food  products.  Among  them 
are  a  number  that,  because  of  their 
unusual  nourishing  qualities,  ease  of  di- 
gestion and  assimilation,  are  particularly 
suited  to  the  diet  of  those  who  cannot 
partake  of  normal  fare. 

N.  B.  C.  Zwieback 

N.  B.  C.  Graham  Crackers 

Bent's  Water  Crackers 

Uneeda  Biscuit 

Water  Thin  Biscuit 

Cracknels  (Egg  Biscuit) 

N.  B.  C.  Oatmeal  Crackers 

Each  product  is  the  best  of  its  kind — hght, 
wholesome,  appetizing,  fresh  and  clean. 
Grocers  sell  them  in  the  convenient  pack- 
ages with  the  famous  In-er-seal  Trade 
Mark,  in  the  familiar  Glass-Front  Cans 
and  in  the  attractive  Small  Tins. 

NATIONAL  BISCUIT 
COMPANY 


481 


Fairchild  Foods  for  the  Sick, 

the  Invalid,  the  Convalescent 

PeptonUed  Milk— whole  milk  with  the  casein  made  soluble  to 
such  a  degree  that  it  forms  only  minute,  flocculent  and  diffusible 
coagula,  thus  avoiding  complications  due  to  the  accumulation  of 
**cheese-like  masses  of  casein"  in  the  intestinal  tract,  affords  all 
the  nourishment  of  plain  milk  and  has  none  of  its  objectionable 
qualities. 

Peptonised  Milk  Gruel  Milk  and  cereal  in  a  highly  agree- 
able and  digestible  form. 

These  foods  are  very  simply  prepared  by  means  of  the  Fairchild 
Peptonising  Tubes  and  "Recipes." 
Recipes  upon  request. 

Junket  Whole  milk  in  a  semi-solid,  jelley-like  form,  especially 

acceptable  to  patients  whose  diet  is  restricted  mostly  to  fluid  foods 
and  who  do  not  well  tolerate  plain  milk. 

V^Hiey  Contains  the  soluble  albuminoids,  sugar  and  saline  consti- 
tuents of  the  milk  and  (in  suspension)  the  particles  of  casein  and 
fat  which  may  pass  through  the  strainer;  conveys  also  the  agree- 
able stomachic  properties  of  the  aromatised  extract  of  the  gastric 
juice  used  in  its  preparation — the  Pepsencia. 
Junket  and  Whey  are  prepared  from  fresh  milk  with  Pepsencia, 
Essence  of  Pepsine,  Fairchild. 

P&nopepton  Contains  in  a  sterile  solution,  in  a  perfectly  diffu- 
sible form,  all  the  highly  nutritious,  stimulant  and  activating 
substances  of  beef  and  wheat;  designed  especially  for  therapeutic 
feeding;  useful  in  the  wide  range  of  cases  where  ordinary  food  ia 
wholly  or  partially  intolerable  and  unfit.  May  be  given  on 
cracked  ice,  or  with  hot  water  like  a  bouillon,  with  Whey,  or  in 
form  of  a  jelly. 
Recipes  upon  request. 

Panopepton  with  Whey — A  teaspoonfui  or  two  of  clean 

cracked  ice  in  a  glass  or  teacup,  a  tablespoonful  of  Panopepton; 
fill  the  glass  or  cup  with  Whey;  sip  slowly. 

Lsiibose  A  dry  concentrated  food  from  whole  milk  and  whole 

wheat.    Made  ready  for  use  simply  by  the  addition  of  water; 
suitable  for  children  and  invalids;  useful  for  nursing  mothers. 
Circular  with  formulas  upon  request. 

Fairchild  Bros.  &  Foster 

New  York 


482 


A  Standardized 
Product. 

The  physician,  whenever  possible,  uses 
drugs,  solutions  and  serums  of  standard 
strength.  This  abolishes  uncertainty.  The 
preparation  of  the  invalid's  food,  how- 
ever, is  left  to  the  skill  of  the  nurse.  How 
much  to  be  desired,  then,  is  a  food  pro- 
duct that  yields  uniform  results  irrespec- 
tive of  such  skill. 


is  a  standardized  product,  thus  differing-  from  those  which 
have  a  variable  water  content,  and  yield  jellies  of  widely 
differing  strengths. 

The  nurse  preparing  Jell-O  knows  exactly  what  her 
patient  will  receive,  and  she  realizes  also  that  she  herself 
is  spared  much  unnecessary  work  by  the  adoption  of  the 
*'easy  Jell-O  way." 

There  are  seven  pure  fruit  flavors  of  Jell-O  :  Strawberry, 
Raspberry,  Orange,  Lemon, 
Cherry,  Peach,  Chocolate. 

10  cents  per  package  at 
groceries  and  general  stores. 

THE  GENESEE  PURE 
FOOD  CO.. 
Le  Roy,  N.  Y..  and 
Bridgeburg,  Can. 

The  name  jKivi.-0  is  on  the 
package  in  big  red  letters. 
.  ■  ^    Be  sure  it  is  jKivVO  and 
.  II    not  something  else. 


483 


For  the  Sick,  Convalescent  or  Well  there  is 
no  finer  energy  producing  food  than 

Minute  Tapioca 

Its  food  value  is  particularly  important  because 
of  its  ready  digestibility  and  its  easy  conversion 
into  bodily  energy.  Minute  Tapioca  is  as  pure 
as  tapioca  can  possibly  be  made  and  is  so  pre- 
pared that  it  softens  immediately,  thus  making 
it  very  desirable  when  a  particularly  nourishing 
and  healthful  dessert  is  required  quickly. 

Try  the  Minute  Tapioca  recipes  in  this  book. 
A  section  of  our  Minute  Cook  Book  is  de- 
voted to  recipes  of  some  especially  dainty, 
nourishing  desserts  for  the  sick 
room. 

It  is  yours  for  the  asking. 
Also  a  Free  sample  for  your 
grocer's  name. 


At  All  Good  Grocers 


Minute  Tapioca  Co. 

223  W.  Main  St. 
Orange,        ...  Mass. 


484 


Welch's 

urapeJiiice 


"M'ATURE'S  own  proauct,  the  pure 
juice  of  perfect  Concords,  rich  in 
invert  sugar,  fruit  acids  and  mineral  salts; 
full  of  that  tart  fruity  flavor  so  w^elcomed  by 
the  fever  sufferer. 

Administer  it  to  your  typhoid  patients,  to 
your  child  sufferers,  in  convalescence  and 
w^henever  your  judgment  recommends  a 
pure  fruit  juice.  It's  an  energizing  appetite 
restorative  w^ith  its  acid  tang  and  delicate 
aroma — a  food  beverage  the  patient  in- 
stantly takes  to  and  never  tires  of,  because 
it  brings  the  cheer  and  vim  of  happy  w^ell 
days  to  come.  Serve  it  cold  in  a  small  thin 
glass. 


Sample  pint  bottles  gladly  sent  post- 
paid to  nurses,  physicians,  sanitariums 
and  hospitals.  Send  for  descriptive 
literature  and  recipes  for  tasty  sick- 
room delicacies.    Free  upon  request. 


The  Welch  Grape  Juice  Co. 

Portage  Street  Westfield,  N.Y. 


485 


National  Head- 
quarters  for 

DIETITIANS 


HOSPITALS  desiring  dietitians 
can  secure  the  services  of  grad- 
uates from  leading  Schools  of 
Household  Arts  by  applying  to 
us.  Prompt  attention  given  to 
request  and  no  charge  is  made 
for  this  service. 

DIETITIANS  desiring  hospital 
positions  are  invited  to  register 
with 

A.  F.  PATTEE 

130  South  First  Avenue, 
Mt.  Vernon,  New  York 


486 


ORIGINAL 


GENUINE 


Pure  full-cream  milk  combined  with 
the  extracts  of  selected  grains 
reduced  to  powder  form 

DELICIOUS,  INVIGORATING, 
NOURISHING 

Selected  recipes  will  be  found  in  this  book  for 
preparing  original  delicacies  from  Horlick^s  Malted 
Milk  that  will  not  fail  to  tempt  the  appetite  of 
fastidious  patients.  Samples  Sent  Free  and  Ex- 
press Paid. 

ASK  FOR 

HORLICK'S 

OTHERS  ARE  IMITATIONS 

HORLICK'S  MALTED  MILK  CO. 

RACINE,  WIS. 


487 


GUM  GLUTE,N 


THE  PURE  FOOD  LAW 

U.  S.  Standard  for  G/uf<?«.— "GLUTEN  FLOUR  is  the  product  made 
from  flour  by  the  removal  of  starch,  and  contains  not  less  than  five 
and  six-tenths  (5.6)  per  cent,  of  Nitrogen,  and  not  more  than  ten  (10^ 
per  cent,  of  Moisture." 

NOTE— Using  the  factor,  6.25,  usually  employed  by  the  U.  S. 
Government  chemists,  Standard  Gluten  Flour  must,  therefore,  shovr 
at  least  thirty-five  (35)  per  cent,  protein. 

■  inifTSA  OIIM  01  IITCil  i*^  ^"Jirantced  to  be  much  richer 
nil  I  I   J|  lllJM  llLUIc.il  in  protein  than  the  Government 

■  IWI  I  \3  MWm  WkVlkN  standard  prescribes. 

The  increase  of  diabetes'  among  young  children  is  noteworthy: 
that  it  may  be  due  to  the  increased  use  of  malted  and  dextrinized 
cereal  foods,  at  a  time  when  the  digestive  organs  are  not  prepared 
to  digest  them,  is  very  probale. 

Cow's  milk  differs  from  mother's  milk  in  that  the  casein  of  cow's 
milk  coagulates  as  soon  as  it  reaches  the  stomach  and  comes  in 
contact  with  the  rennet  ferment,  into  a  cheese-like  mass,  which 
is  not  easily  broken  up  and  digested  by  the  delicate  stomach  of  the 
infant;  while  the  casein  of  mother's  milk  forms  a  flaky  coagula, 
which  is  easily  penetrated  by  the  digestive  juices.  To  prevent 
cow's  milk  from  coagulating  into  a  cheese-like  mass,  various  food 
substances  are  added.  Hoyt's  Gum  Gluten  Flour  is  especially 
suited  to  this  purpose. 

Hoyt's  Gum  Gluten  resembles  milk  in  that  its  chief  element 
is  nitrogenous,  and  of  the  same  muscle-forming  character  as 
casein,  and  require  essentially  the  same  ferments  for  their  proper 
digestion. 

When  impossible  for  an  infant  to  retain  other  food  in  the 
stomach,  Hoyt's  Gum  Gluten  Flour,  made  into  a  gruel,  may  be 
retained,  and  give  strength,  after  which  milk  and  milk-sugar  may 
be  added. 

SWiLETINA 

A  bottle  will  be  mailed  to  any  address  upon  receipt  of  25c. 

NEW  PRODUCTS 

GUM  GLUTE.N  DAINTY  FLUFFS 

These  are  most  delicate  and  nutritious,  containing  more  than  80?^ 
protein  and  less  than  10^  starch. 

GUM  GLUTEN  B'LOUR  may  be  used  in  as  many  different  ways  as 
white  flour,  thus  making  a  variety  to  the  starch  restricted  diet. 

We  would  be  pleased  to  mail  you  a  book  of  recipes  for  the  use  of  our 
Products  and  would  appreciate  hearing  from  nurses  as  to  the  results 
obtained  from  the  use  of  our  products  in  various  cases. 

HOW  PROCURED 

As  a  rule  the  leading  grocer  in  a  city  is  agent  for  Hoyt's  Gum 
Gluten.  If  not  easily  procured  write  us  and  we  will  gladly  send  you 
name  of  our  nearest  agent,  price-list  and  starch  restricted  menu. 
Send  us  a  2c  stamp  and  we  will  forward  you  a  sample  of  our 
DAINTY  FLUFFS. 

PURE  GLUTEN  FOOD  CO. 

90  W.  BROADWAY  NEW  YORK 


488 


PURITY  ABSOLUTE       FLAVOR  UNIQUE 
NOTHING  FINER  PRODUCIBLE 


**It  is  our  opinion  the  analytical  tests  of  the  UNITED  STATES 
BUREAU  OF  CHEMISTRY  prove  NICELLE  OLIVE  OIL 
superior  to  all  known  brands  tested."— STILL  WELL  &  GLADDING, 
Official  Chemists  to  New  York  Produce  Exchange. 

Its  Use  Recommended  by 

Miss  AUDA  FRANCES  PATTEE       Miss  CORNELIA  C.  BEDFORD 
Miss  FANNIE  MERRIT  FARMER       Miss  JANET  MACKENZIE  HILL 
Mrs.  HELEN  ARMSTRONG  Miss  ANNA  BARROWS 

AND  OTHERS 


NICELLE  OUVE  OIL  CO. 

96  Warren  Street,  New  York  City 

FOREIGN  OFFICES: 
PARIS,  10  Avenue  de  TOpera  NICE,  7  Place  Defly 


489 


GOOD  THINGS  TO  EAT 

THAT  ARE 

HOME  MADE 

PRESERVES,  MARMALADES,  PICKLES, 
RELISHES,  JELLIES,  MINCE  MEAT, 
PLUM  PUDDING. 


This  Kitchen  is  under  the  personal  supervis- 
ion of  Miss  Cliivvis,  who  assures  the  pubHc  that 
only  the  purest  and  best  goods  are  used  in  her 
estabHshment. 


SPECIALTIES 

GINGER  PEARS,  GRAPE  CONSERVE, 
SPANISH  PICKLE,   CENTURY  RELISH. 


Special  prices  to  Hospitals^  Hotels^  Clubs^  etc. 

F*ric©  list  fTj.rrx.isti.ed.  on  application. 

C.  E,  CHIVVIS,    -    -  MOUNT  VERNON,  NEW  YORK 


490 


First  Aid 

to  the 

Nurse 

And  a  Relish 
for  the  Patient 

Franco- American 

Broths  for  Invalids 

Beef  Broth,   Chicken  Broth,  Mutton  Broth, 

In  Sanitary  Tins  15  cents  each 

Ready  to  Serve 
Convenience  —  Uniformity  —  Results 

Franco-American  Broths  for  Invalids  are  High  in  Food 
Value  and  are  invaluable  for  patients  requiring  a  nutritive 
broth. 

They  are  prepared  without 
seasoning  and  can  be  retained 
by  the  most  delicate  stomach. 

Endorsed  by  Eminent  Physicians 

Sample  sent  to  Nurses  Free  upon  request. 

The  Franco-American 
Food  Company 

Jersey  City      -    N.  J.  U.  S.  A, 


491 


Liquid  Peptonoids  (Emergency  Food) 


When  there  is  dislike  for  ordinary  food,  or 
inability  to  digest  or  assimilate  it,  to  main- 
tain strength  and  tide  over  the  emergency. 

Lactopeptine  (Digestant) 

When  inability  exists  to  digest  food,  and 
digestive  secretions,  enzymes  and  functional 
activity  need  to  be  assisted  or  augmented. 

Borolyptol  (Antiseptic) 

Thoroughly,  pleasantly  and  promptly  disin- 
fects, deodorizes  and  opposes  germ  action 
w^ithout  irritating  or  any  change  of  poisonous 
action. 


The  Arlington  Chemical  Company 
The  New  York  Pharmacal  Association 
The  Palisade  Manufacturing  Company 
Yonkers,  New  York 


Holt's  Noblesse  Flour 

For  the 

Household       Hospital       Sick  Room 

Noblesse  Flour  bears  the  same  relation  to  ordinary  flours  that 
CREAM  does  to  MILK. 

It  is  a  small  portion  of  the  very  heart  of  selected  grains  of 
wheat,  carefully  separated  and  milled  so  as  to  retain  their  best 
and  most  nutritive  elements  and  exclude  all  impurities  and  indi- 
gestible fibre. 

ANALYSIS 
Moisture  11.23?fc 

Ash  32  FOOD  VALUE 

Fat  93  —     35.154  Calories  per  pound. 

Protein   10.61  —  288.592 

Carbohydrates   ....    76.91_— 1461.48 
100.  1785.226 

The  Author  of  "Practical  Dietetics'*  voluntarily  gives 
Noblesse  Flour  her  unqualified  approval  for  use  in  hospitals  and 
sick  rooms  and  strongly  recommends  it  to  all  nurses  and  dietitians. 

If  you  cannot  secure  it  through  your  regular  source  of  sup- 
plies write  to 

HOLT  &  COMPANY 

95  Broad  Street,  New  York 


493 


A  NEW  EDITION  REVISED  AND  ENLARGED 


INSTITUTION  RECIPES 


FOR  USE  IN 

SCHOOLS,  COLLEGES,  HOSPITALS. 
AND  OTHER  INSTITUTIONS 

By  EMMA  SMEDLEY 


Superintendent  of  High- School  Luncheons,  Philadelphia,  Pa.;  Formerly 
Instructor  in  Domestic  Science,  Drexel  Institute,  Philadelphia ;  and 
Instructor  in  Dietetics,    The  Johns  Hopkins  Hospital 
Training  School  for  Nurses,  Baltimore,  Md. 


HIS  work  will  prove  indispensable  to  the  dietitian  in 


schools,  hospitals  and  other  institutions  where 
attractive,  wholesome  and  economical  food  in  large 
quantities  is  demanded. 

The  recipes  have  been  carefully  tested  in  actual 
daily  use,  and,  unlike  the  usual  cookery  book  designed 
for  use  in  the  home,  they  are  here  given  in  quantities  to 
serve  either  fifty  or  one  hundred  and  fifty  portions. 

In  addition  to  the  many  valuable  recipes,  the  book 
contains  chapters  which  deal  with  the  equipment  of  the 
institution  kitchen,  and  the  equipment,  menu  and  ad- 
ministration of  the  high-school  luncheon. 

Institution  Recipes  has  been  greatly  appreciated 
by  all  who  have  used  it,  and  this  enlarged  edition  will 
answer  the  repeated  requests  for  a  fuller  treatment  of 
the  subject. 


Price,  $1.25  net      By  Mail,  $1.35     C.  0.  D.,  $1.50 


FOR  SALE  BY 


A.  F.  PATTEE,  Mt.  Vernon,  New  York 

494 


Sold  by  all  good  grocers  always  in  the  Red, 
White  and  Blue  Checkerboard  Package 


Gelatine  was  first  made  by  J.  &  G.  Cox  as  a  substitute 
for  calves'  feet  in  the  preparation  of  a  nutritious  food 
for  invalids,  about  the  year  1845.  It  v^as  for  many 
years  sold  only  by 
druggists  as  a  specific 
through  medical  sug- 
gestion. 

Cox's  Manual 

of 

Gelatine 
Cookery 

which  contains  an  end- 
less variety  of  Recipes 
will  be  mailed  free  on 
request. 

The  Cox  Gelatine  Company 

(Representing  J,  &  G.  Cox,  Ltd.^  Edinburgh^  Scotland) 

98  Hudson  Street,  New  York 


495 


HOSPITALS 


HOSPITALS  desiring 
Dietitians  can  secure  the 
services  of  graduates  from 
leading  Schools  of  House- 
hold Arts  by  applying  to 
A.  F.  Pattee,  130  South 
First  Avenue  Mt.  Vernon, 
New  York. 

Prompt  attention  given  to 
request  and  no  charge  is 
made  for  this  service. 


496 


THERAPEUTIC  APPLICATION  OF  GUM  GLUTEN 

Dyspepsia,  Gastritis,  etc. — Being  non-fermentative  and 
quickly  reduced  by  the  digestive  fluids,  Gum  Gluten  is  a  food  in 
perfect  harmony  with  the  action  of  the  stomach  and  can  be  eaten 
in  the  form  of  gruel. 

Convalescence. — As  Gum  Gluten  is  remarkably  rich  in 
nucleo-albumen  and  all  other  cell-building  material,  it  is  capable 
of  greatly  quickening  and  intensifying  the  integrating  processes 
of  cell  life  and  giving  impulsive  energy  and  force  in  the  revival 
of  the  system  to  its  normal  metabolism. 

Rheumatism,  Gout  and  Uric  Acid  Diathesis. — Being 
non-acid  making  and  non-fermenting,  and  digested  by  the  action 
of  the  stomach,  Gum  Gluten  has  a  distinct  specific  value  in  all 
rheumatic  conditions. 

Obesity. — As  Gum  Gluten  is  the  muscle-building  element 
of  wheat,  it  is  the  rational  unfailing  cure  of  this  uncomfortable 
condition. 

Diabetes  Mellitus. — Gum  Gluten  can  be  made  into  bread 
and  a  great  variety  of  dishes,  and  is  the  most  satisfactory  substi- 
tute for  the  wheat  flour  bread  or  bread  in  common  use,  and  the 
effects  are  particularly  noticeable  in  the  reduction  of  sugar  in  the 
daily  tests. 

Other  Conditions. — All  anaemic  and  chlorotic  conditions 
due  to  an  insufficient  supply  of  red  blood  corpuscles  or  lack  of 
haemoglobin,  or  both,  and  more  remotelv  to  a  disordered  nutri- 
tion, are  furnished  the  one  thing  needed  by  Gum  Gluten. 

For  Nursing  Mothers. — It  enriches  the  lacteal  secretions. 

For  Infants'  Food. — To  increase  the  amount  of  protein  Gum 
Gluten  Flour  should  be  added  to  cow's  milk  to  keep  it  from 
coagulating  and  fermenting. 

For  the  expectant  mother  it  supplies  the  prenatal  aliment  par 
excellence,  since  it  is  rich  in  all  those  elements  which  serve  to 
maintain  the  nutritive  system  at  its  best. 

For  the  Aged,  the  Enfeebled,  the  Invalid,  and  all  whose 
vital  powers  are  waning.  Gum  Gluten  will  be  found  a  most 
wholesome,  sustaining  and  helpful  food.  In  its  blood-making 
property  it  restores  to  the  system  the  loss  which  has  resulted  in 
enervation  and  decline. 

Write  us  for  price-list  and  our  new  starch  restricted  diet-list 
to  give  out  to  your  patients. 

PURE  GLUTEN  FOOD  COMPANY 

90  W.  BROADWAY  NEW  YORK 


497 


DIETITIANS 


DIETITIANS  desiring 
Hospital  positions  are  in- 
vited to  register  with  A. 
F.  Pattee,  130  South  First 
Avenue,  Mount  Vernon, 
New  York. 

No  charge  for  registration 
is  made  and  only  nominal 
charge  if  position  is  secured. 


498 


Thompson's 
Vegetable  and  Cereal  Flour 


have  no  equal  for  soups,  purees  and  pas- 
tries, can  be  prepared  in  20  minutes  a 
great  saving  of  time,  labor  and  fuel.  Are 
manufactured  from  first  quality  grains  and 
cereals,  thoroughly  sterilized,  hulls  and  all 
impurities  removed,  using  only  the  most 
nutritious  parts  of  the  kernel  in  the  manu- 
facture of  our  flours  which  are  at  all  times 
the  highest  standard  of  purity.  From 
three  to  four  hundred  pounds  of  undigest- 
able  matter  is  removed  from  every  ton. 


PEA. 


'9! 


Nothing  so  tasty  and  appetizing  as  a  dish  of  puree  or 
cream  of  pea,  prepared  from  Thompson's  Green  or  Yel- 
low pea  flour,  only  the  most  nutritious  part  of  the  best 
select  peas  are  used  for  this  flour. 

BEAN.  Bean  soup,  muffins  or  griddle  cakes  made  from  Thomp- 

son's White,  Black  or  Red  beans  can  be  eaten  and  di- 
gested by  the  weakest  stomach  without  suffering  the  dis- 
tress so  often  experienced  after  eating  of  dishes  prepared 
from  the  whole  beans. 
LENTILS.     Lentils  are  one  of  the  oldest  Legumes  known  to  civiliza- 
tion, they  have  been  used  as  a  food  for  thousands  of  years,  on 
account  of  their  great  and  well  balanced  food  values,  con- 
taining a  high  per  cent  of  protein,  fat  and  carbohydrates. 
Rice  and  Barley  Flours  are  unequaled  for  making  pas- 
tries of  the  highest  quality,  and  are  indispensable  for  making 
Rice  or  Barley  water,  gruel,  soups  etc.,  for  infants  and  inval- 
ids, and  enjoyed  and  relished  by  the  well  and  robust  person. 
Stood  the  highest  test  for  economy  and  for  excellency 
of  quality. 

Has  the  high  approval  of  the  United  States  Navy  De- 
partment by  whom  it  is  authorized  and  recommended. 

Put  up  in  10  and  25  cent  friction  top  cans,  2  and  4  dozen  to  the 
case.  Also  put  up  in  5,  10  and  60  pound  cans,  half  barrels  and 
barrels.    If  your  grocer  does  not  have  it  write  the 

Thompson  Milling  Company 

1431-33  Catherine  Street 

Philadelphia,  Pa.  U.  S.  A. 


RICE 
AND 
BARLEY. 


499 


NURSES'  JOURNAL 
COMBINATION  OFFERS 

The  Following  Offers  Apply  to  New  Subscriptions  Only 
The  Trained  Nurse  (2.00)  and  one  copy  of 


Pattee's  Practical  Dietetics  (1.50)   ....  3.25 

The  American  Journal  of  Nursing  (2.00) 

and  one  copy  of 

Pattee's  Practical  Dietetics  (1.50)  .  .     .  .  3.25 

The  Nurse  (2.00)  and  one  copy  of 

Pattee's  Practical  Dietetics  (1.50)    ....  3.25 

The  Dietetic  &  Hygienic  Gazette  (1.00) 

and  one  copy  of 

Pattee's  Practical  Dietetics  (1.50)  ....  2.25 


The  Canadian  Nurse  (1.50)  and  one  copy  of 

Pattee's  Practical  Dietetics  (1.50)  ....  2.75 

The  Nurses'  Journal  Of  The  Pacific  Coast 


(1.50)  and  one  copy  of 

Pattee's  Practical  Dietetics  (1.50)  .  .     .  .  2.75 

The  Modern  Hospital  (3.00)  and  one  copy  of 

Pattee's  Practical  Dietetics  (1.50)  ....  4.25 

The  National  Hospital  Record  (.60)  and 
one  copy  of 

Pattee's  Practical  Dietetics  (1.50)  ....  2.00 

The   Red   Cross    (.50)    and   one   copy  of 

Pattee's  Practical  Dietetics  (1.50)  ....  1.90 

The  American  Cookery  Magazine  (1.00) 

and  one  copy  of 

Pattee's  Practical  Dietetics  (1.50)  ....  2.25 


A.  F.  PATTEE 

134  South  First  Avenue 
Mount  Vernon,  N.  Y. 


500 


BREAD 

The  Food  With  The  Energy  Value 


"Measured  by  actual  nutritive  power,  there  is  no 
other  complete  ration  which  in  economy  can  compare 
with  Bread;*    (U.  S.  Gov't.  Bulletin.) 

You  can't  be  interested  in  dietetics  without  being 
interested  in  Bread — Wheat  Bread,  Graham  Bread, 
Rusks,  Toast,  etc.  The  book  pictured  above  was  com- 
piled by  teachers  of  domestic  science. 

You  can  have  a  free  copy  if  you  write  us 

The  Fleischmann  Co. 

701  Washington  St.,  New  York,  N.  Y. 


501 


'I  am  constant  as  the  northern  star, 
Of  whose  transfix'd  and  resting  quality 
There  is  no  fellow  in  the  firmament." 

—  Julius  Ccesar, 


502 


Dear- 
Doctoi^ 

"^^vdinQ  of  Kumyss  as 
a  tod,  in  almo^ii^vcfV^ 
morbid  condition  oispocial^ 
whent&e  stomach  and  ntim- 
tion  aro  involved ,  is  so  woU 
Known  t&iat  it  seems  supor- 
flttotts  to  catljour  attantion 
to  it'iS  moritiS^n>uttliQre  avQ^ 
just  now,  so  mannimitations 
and  so  ttittcli  stinslitutin^ 
that  I  wish  to  call  jK>ur  atten- 
tion to  tho  fact  that  all  the 
genuine  is  stoppered  with 
crown  caps  marked 

DR.  E.   F.  BRUSH 

LABORATORY.   MOUNT  VERNON.  N.  Y. 
N.  Y.  Office,  217  W.  123d  St. 


503 


National  Head- 
quarters  f  o  r 

DIETITIANS 


HOSPITALS  desiring  dietitians 
can  secure  the  services  of  grad- 
uates from  leading  Schools  of 
Household  Arts  by  applying  to 
us.  Prompt  attention  given  to 
request  and  no  charge  is  made 
for  this  service. 

DIETITIANS  desiring  hospital 
positions  are  invited  to  register 
with 

A.  F.  PATTEE 

130. South  First  Avenue, 
Mt.  Vernon,  New  York 


504 


After  the 
Dietetics — 
then  the 
Dishwashing 

sectional  View 

Of  equal  importance  with  Correct  Diet  is 
Correct  Dishwashing 

The 

Walker  Dishwasher 

is  highly  efficient  — 

is  sanitary — 

is  simple  to  operate  — 

is  easy  to  maintain  — 

thoroughly  sterilizes  the  dishes  — 

eliminates  breakage  — 

has  large  capacity  — 

and  is  a  real  satisfaction. 

For  Homes,  Hospitals,  Schools,  Restaurants,  etc. 

Send  for  beautifully  Illustrated  booklet 

"WASHING  YOUR  DISHES" 


WALKER  BROTHERS  COMPANY 

215  WALTON  STREET,  SYRACUSE,  N.Y. 


505 


THE 


Gazette  Pocket  Speller  and  Def  iner 


{Second,  Revised  Edition) 


Wie  Gazettb 
Pockbt:-Sprller 

ANO 

ENGLISH  AW  A'WDICA  L 


REVIEWS 

An  extremely  conveni- 
ent little  manual. 

—Med.  Record, 

A  very  convenient  vest- 
pocket  reference  book* 
— Journal  Am.  Med, 
Assn. 

Tt  is  certain  to  be  popu- 
lar.—J/ajj.  Med.  Jour- 
nal. 

It  surpasses  all  the 
smaller  d ictionarics 
published. 

—Med.  Brief, 

It  is  remarkably  com- 
plete, condensed  and 
comprehensive. — 
(ONE-FOURTH  SIZE}  Atlanta  Constitution. 

Price,  so  cents 

Send  for  Specimen  Pages  and  Other  Particulars 
THE  DIETETIC  AND  HYGIENIC  GAZETTE 
206  Broadway  New  York  City 


THIS  unique  volume 
is  a  combined  Eng- 
lish and  Medical  dic- 
tionary. It  is  a  marvel 
of  Correctness,  Com- 
pactness and  Complete- 
ness. Bound  in  leather 
and  gilt. 


506 


iiiiiiiiiiiiiiii^;^iiiiiiiiiMiirTw 


^^iiiniiiiiiiiiiii>^ 


i 


Are  ready  for  wear  and  meet 
the  requirements  of  the  most 
fastidious. 

All  nurses  who  would  wear  strictly  tailored  and 
extremely  smart-looking  uniforms,  should  insist  upon 
having  the  Dix-Make  label  in  the  garments  when 
buying. 

Made  with  utmost 
care  and  precision  of 
standard  materials,  in 
all  sizes. 

Sold  by  Department 
Stores  Eueryuuhere 


The  Dix-Make  has 
been  selected  as  the 
ofiicial  uniform  of  the 

American 
Red  Cross 


Write  for  hook  of  styles ^ 
samples  of  materials ^ 
etc.    Address  Dept.  H, 

Henry  A.  Dix  4  Sons 

Company 
Dix  Building,        New  York 


No.  666 


nTTTTTT>^<mmTrmm 


507 


Not  What  We  Have  But  What  You  Want" 


Est.  1890 


Telephone 
Greeley 

406-409 


HOME  BUREAU 

Foods  for  Invalids,  Diabetics,  Children 
52  West  39th  Street,  New  York  City 
Telephone  406-409  Greeley 

Nurses— For  every  kind  of  a  case  hospital  and  private. 

Delicacies—For  the  Sick,  Broths,  Purees,  GrUels,  Beverages,  Jellies, 
Eggs,  etc.,  on  hand  and  to  order,  Manuel  Freres*  Swiss  products. 

Surgical  Dressings— For  Operations,  Sterilized  Maternity  Outfits  in 
sealed  boxes,  Laparotomy  Kits,  Adenoid  and  Tonsilitis  Sets. 

Medical  Supplies— of  every  kind  for  the  sick  room  and  the  hospital. 

Invalid  Furniture— Chairs,  Back  Rests,  Bed  Trays,  Stretches,  Oper- 
ating Tables,  Sterilized  Sheets,  Towels,  Surgeons'  Gowns,  etc., 
sold  and  rented. 

Invalids  Moved— anywhere  from  city  to  country,  and  house  to  house, 
room  to  room,  and  up  and  down  stairs. 

Rest  Cure  Apartments— attractively  and  daintily  furnished  for  con- 
valesecent  and  rest  cure  patients. 

Houses  and  Rooms— fumigated  and  disinfected  by  the  most  approved 
methods  without  annoyance  to  householders  or  patients. 

Purchases— made  of  anything  for  hospitals,  physicians,  nurses  and  in- 
valids.   Photographs  submmitted,  estimates  furnished. 

Mail  Orders— for  sick  room  and  hospital  supplies  promptly  and  efficient- 
ly filled. 

Information— given  about  everything  pertaining  to  the  sick  room  and 
hospital.    Sanatoriums,  and  Houses  recommended. 

Open  Day,  Night,  Sunday  and  Holidays 


508 


IDEAL  NURSE  REPOR-T 


Date  Hour  Tern.  Pulse  Res.  NOURISHMENT  MEDICINE  Urine  B.M.  Sleep 


REMARKS 


Above  Reports  in  pads  of  100  sheets ^  50  cents 

Wm.  V.  Willis  &  Co. 

Surgical  Instruments  and 
Hospital  Supplies 

134  South  11th  Street,  Philadelphia,  Pa. 

Headquarters  for  all  Nursing  Supplies,  Pocket 
Instrument  Cases,  Nurse  Bags,  Bandage 
Scissors,  Thermometers,  Back  Rests,  Roll- 
ing Chairs.    Write  for  catalog. 

Bound  booklets  of  50  bills  as  illustrated  below,  50  cents. 

Keep  a  stub  record  of  your  cases 
and  present  a  neatly  printed  bill. 


IDEAL  RECORD 

as?  BILL  BOOK 


Name.  

Address ... 


...days  attend- 


„  Per  week .... 
Expenses 
Laundry^ 
Totals 


Date  arrived.  .. 

Date  up  

Date  paid  


for. 


 days'  attendanu.... 


...Dollars  a  week 


Expenses,  traveling,  etc.... 

Laundty  work  ,   .  .   

Total   

Received  Payment. —  _  -  


509 


NURSES'  JOURNAL 

Send  your  subscriptions  to 

A.  F.  Pattee 

MOUNT  VERNON 
NEW  YORK 

The  Trained  Nurse  (issued  monthly)  per  year  2.00 

The  American  Journal  Of  Nursing  (issued 

monthly)  per  year  2.00 

The  Nurse  (issued  monthly)  per  year  ....  2.00 

The  Dietetic  &  Hygienic  Gazette  (issued 

monthly)  per  year  1.00 

The  Canadian  Nurse  (issued  monthly)  per 

year  1.50 

The  Nurses'  Journal  Of  The  Pacific  Coast 

(issued  monthly)   per  year  1.50 

The  Modern  Hospital  (issued  monthly)  per 

year  3.00 

The  National   Hospital  Record  (issued 

monthly)  per  year  60 

The  National  Red  Cross  (issued  monthly) 

per  year  50 

The  American  Cookery  Magazine  (issued 

monthly)  per  year  1.00 


510 


Support  for  Arch  and  Ankle 

is  an  every -day  necessity  for  nurses  and  others, 
whose  occupations  keep  them  on  their  feet  the 
greater  part  of  the  time.  The 

COWARD  SUPPORT  SHOE 

With  Coward  Extension  Heel 

is  constructed  on  corrective  principles  which  give 
a  secure  rest  to  the  arch,  and  furnish  a  helpful 
support  to  ankles  that '  'turn-in. ' '  An  easy,  com- 
fortable shoe,  immediately  beneficial  to  weak  arch 
structures,  and  which  relieves  and  prevents 
*'flat-foot." 

Coward  Arch  Support  Shoe  and  Coward  Extension  Heel,  have  been 
made  by  James  S.  Coward, in  his  Custom  Department,for  over  34  yrs. 

JAMESS.COWARD,264.274GreenwkhSt.N.Y. 

(NEAR  WAKREN  STREET) 

Mall  Orders  Filled     SOLD  NOWHERE  ELSE      Send  for  Catalogue 
 ! 


511 


The  BEST  WORK  PUBLISHED  for 
HOSPITAL  INTERNES  and 

SURGICAL  NURSES 


THE  SURGICAL  ASSISTANT 

(second  edition) 
BY 

WALTER  M.  BRICKNER,  B.S.,  M.D. 

Assistant  Adjunct  Surgeon,  Mount  Sinai  Hospital,  New 
York,  and  Chief  in  Surgical  Out-patient  Department; 
Surgeon  to  N.  Y.  Sanitarium  for  Hebrew  Children. 


The  Most  Comprehensive  Manual  on  Operating  Room 
Technic  and  Methods. 

It  is  replete  with  definite  instructions,  useful  hints  and  valuable  "wrinkles"  not 
elsewhere  set  down  in  print. 
It  details : 

The  Oeneral  Conduct  of  the  JLaslstant;  the  Interne;  Assistance  at 
Dressings.  Fracture  Reductions,  etc.  Preparation  of  an  Operating 
Room.  The  Technic  of  JLsepsls  In  all  Its  Practical  Rearlnffs.  Prep- 
aration of  the  Patient.  The  Anesthetist.  Preservation  and  Sterili- 
zation of  Instruments  and  Accessories.  Formulas  and  Methods  of 
Surgical  Sterilization.  How  to  **Hand*'  Instruments.  Technics  of 
Assistance  in  the  Various  Operative  Manipulations.  Immediate 
After-Cure  of  the  Patient.  Formulae  of  Solutions,  etc.  Instruments 
and  Accessories  (and  their  preparation)  for  each  operation,  etc.,  etc. 


The  07z/y  book  that  is  devoted  to  the  methods  aiid  duties  of  those  who  ASSIST 
the  surgeon,  and  contains  descriptions  of  all  the  important  operations,  step  by 
step,/ri?w  the  assistants  sta^tdpoint. 

Bound  In  Cloth,  363  Pages.       Price,  $2.00  Postpaid.      123  Original  Illustrations. 

ADDRESS 

INTERNATIONAL  JOURNAL  OF  SURGERY  COMPANY 

Medical  Publishers 

100  WILLIAM  STREET,  512  NEW  YORK,  U.  S.  i 


Treatment  without  internal  medication  is  highly  desirable  in  Whooping 
Cough  and  Spasmodic  Croup,  particularly  in  the  very  young.  The  value 
of  Vapo-Cresolene  depends  upon  its  antiseptic  power  and  the  sedative 
influence  of  the  vapor  diffused  through  the  air,  and  thus  constantly 
breathed  by  the  patient.  Breathing  becomes  easy,  desire  to  cough  is 
allayed  and  the  patient  gains  needful  rest. 

The  diseases  in  which  Cresolene  has  been  especially  utilized 
are  Whooping  Cough,  Spasmodic  Croup,  Bronchitis,  Asthma, 
Broncho-pneumonia,  the  bronchial  complications  of  Scarlet  Fever 
and  Measles  and  as  an  aid  in  the  treatment  of  Diphtheria. 

A  1%  solution  of  Cresolene  in  water  kills  the  germs  of  Diphtheria, 
Typhoid  Fever  and  pus  at  once.  Cresolene  is  less  toxic  than  carbolic 
acid  and  has  a  greater  germicidal  value. 

For  sale  by  Druggists.  Literature  on  request. 

THE  VAPO-CRESOLENE  CO. 

62  Cortlandt  Street,  New  York  City. 

Leeming-Miles  Bv?ilding,  Montreal,  Canada. 


513 


THE  "NEAL" 


PORTABLE  RUBBER 
BATHTUB  FOR  CHILDREN 


This  unique  and  pretty  little  Sanitary  Bathing  Apparatus  for 
Infants  is  one  of  the  best  and  most  useful  bathtubs  on  the 
market.  It  has  been  in  active  use  over  fifteen  years  and 
has  found  its  way  into  some  of  the  finest  Nurseries  on  both 
continents.  The  "Neal"  Bathtub  has  been  successfully 
used  in  place  of  an  incubator  for  premature  and  delicate 
babies.  By  wrapping  the  infant  in  soft  woolen  blankets 
and  placing  hot-water  bags  around  the  child,  the  rubber 
keeps  its  uniform  heat,  and  at  the  same  time  insures 
plenty  of  fresh  air,  and  is  of  easy  access  to  Physician  and 
Nurse.  This  has  been  successfully  tried  in  a  number  of 
cases.  The  inventor  of  this  little  bathtub  is  a  graduate  of 
the  New  York  City  Hospital  Training  School  for  Nurses. 
For  further  particulars  send  for  catalogue  and  price  list  to 
Miss  S.  C.  NEAL,  Patentee  and  Manufacturer,  96  FIFTH 
AVENUE,  New  York  City,  U.  S.  A. 


514 


THE  STORM  BINDER  AND 
ABDOMINAL  SUPPORTER 

(PATENTED) 


Special  Kidney  Belt  Inguinal  Hernia  Modification 

Adapted  to  Uise  of  Men,  Women, 
Children  and  Babies 

Modifications  for  Hernia,  Relaxed  Sacroiliac 
Articulations,  Floating  Kidney,  High  and  Low 
Operations,  Ptosis,  Obesity,  Pregnancy,  etc. 

Send  forneuu  folder  and  testimonials  of  physicians .  General  mail 
orders  filled  at  Philadelphia  only — ivithin  tuuenty-four  hours. 

KATHERINE.  L:  STORM,  M.  D. 

1541  DIAMOND  STREET.         -  PHILADELPHIA 


515 


EXCELSIOR 

QUILTING  COMPANY 


The  Excelsior  Quilting 
Company  make  Quilted  Pads 
of  the  correct  weight  for 
washing  properly  and  of  best 
material.  Their  ^ 'trade  mark'* 
is  on  every  pad  which  they 
guarantee  to  be  sanitary  and 
perfect.  Be  careful  and 
guard  your  beds  against 
''sweat  shop  goods'' and  imi- 
tations which  unscrupulous 
dealers  ofifer  you  because 
they  make  more  profit. 


Look  carefully  at  this 
trade  mark  so  you  will  know 
it  when  you  go  to  **shop". 


None  genuine  without 


Trade  Mark.' 


516 


THE  THREE  (3)  HYGEIA  NURSING  BOTTLES 

TAKE  YOUR  CHOICE 


The  Non-break- 
able Hygeia 


THE  NON-BREAKABLE 
HYGEIA  is  made  without  glass. 
There  is  nothing  to  break.  The  cozy 
keeps  the  food  warm.  The  food- 
bag  collapses,  and  air  does  not 
enter  the  bottle.  Only  two  parts  to 
clean,  and  these  two  parts  can  be 
turned  inside  out,  something  im- 
posible  with  any  other  nurser.  The 
food-bag  is  made  of  pure  gum,  and 
lasts  a  long  time,  so  that  the 
breast-nipple  is  about  the  only 
part  necessary  to  replace  frequently. 

THE  TWIN  HYGEIA  is  open 
at  both  ends,  so  the  food  cavity  is 
easily  accessable  for  cleaning.  It 
has  two  breasts  one  of  which  forms 
the  base  of  the  bottle.    This  can 


B— Breast 
J — Jacket  open  at 
the  bottom 

V — Vent  in  jacket  ,  ,  ,  , 

s— Food  bag  goes  be  Vented  or  not,  as  preferred. 

down  as  food 

goes  out.  THE  REGULAR  HYGEIA  so 
long  and  favorably  known,  is  now  brought  out 
with  a  new  breast,  with  hidden  shield,  which 
prevents  baby  taking  any  portion  of  the  breast 
into  its  mouth. 

ALL  PARTS  SOLD  SEPARATELY 

BY  ALL  DRUGGISTS 
THE  BALL-CUP  NIPPLE,  which  has  the 
puncture  at  the  bottom  of  the  cup,  away  from  the 
tip,  where  it  is  protected  from  enlargement,  regu- 
lates feeding  better  than  any  other  nipple  on 
the  market,  and  will  not  collapse.  It  is  a 
small  nipple  for  a  small  neck  bottle  only. 
WRITE  FOR  OUR  BOOKLET 


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BUFFALO,  N.  Y. 


OF 

INESTIMABLE  VALUE  TO  NURSES. 


Guiding  Principles  in  Surgical  Practice 

BY 

Frederick-Emil  Neef,  B.  S.,  M.  L.,  M.  D. 
Adjunct  Prof,  of  Gynecology,  Fordham  University  School  of  Med., 
New  York  City. 

180  Pages.    Illustrated.    Price  $1.50 

This  book,  which  contains  a  wealth  of  information  for 
the  nurse,  is  the  result  .of  clinical  studies  in  the  operating 
room  and  at  the  bedside  of  the  patient.  While  not  a 
text-book  upon  surgery,  it  answers  the  questions  the 
text-book  does  not. 

It  covers  the  practical  points  in  the  preparation  of  the 
patient  for  an  operation,  the  arrangement  of  the  operating 
room,  the  important  relations  between  the  surgeon  and 
the  Anesthetist,  the  assistant,  the  family  physician,  the 
nurse  during  the  course  of  the  operation,  also  the  after 
care  of  the  case. 

Other  chapters  in  the  book  cover  such  important  con- 
siderations as  Sterile  Washes  and  Wound  Dressings. 
Sterilization  of  Utensils  and  instruments  for  the  opera- 
tion. The  Surgeon's  Hands.  Wound  Healing  and 
Scar  Formation,  Asepsis,  Suture  Material,  Anaesthesia, 
Incision,  The  Course  of  the  Operation.  Care  of  the 
Patient  after  Operation,  The  Treatment  of  Unclean 
Wounds,  in  fact,  within  this  book  of  1 80  pages  will  be 
found  those  very  necessary  essentials  that  guide  in  the 
successful  handling  of  operative  work. 

Reference  is  facilitated  by  a  good  index  and  by  prominent 
marginal  headings  in  contrasting  colors. 


Surgery  Publishing  Company,  92  William  St.,  N.  Y. 

518 


National  Head- 
Quarters  for 


DIETITIANS 


HOSPITALS  desiring  dietitians 
can  secure  the  services  of  grad- 
uates from  leading  Schools  of 
Household  Arts  by  applying  to 
us.  Prompt  attention  given  to 
request  and  no  charge  is  made 
for  this  service. 

DIETITIANS  desiring  hospital 
positions  are  invited  to  register 
with 


519 


THE 


Pennsylvania  Orthopaedic  Institute 


AND 

School  Of  Mechano-Therapy 

Cincorporated) 

1709-1711  Green  Street       -       Philadelphia,  Pa. 
COURSES  IN  MEIDICAL  MASSAGE 
Swedish  Movements,  Medical  and  Orthopaedic 
Gymnastics 
Term:  4  Months  -         Tuition  Fee,  $100.00 

Course  in  Electro-Therapy 
Term;  2  Months     •      -  Tuition  Fee,  $30.00 

Course  in  Hydro-Therapy  in  all  its  Forms 
Term:  6  Weeks  -  Tuition  Fee,  $35.00 

Classes  open  in  January,  March,  May,  July 
and  October 

All  courses  may  be  commenced  at  the  same  time  and  finished  within  four 
months.  The  instruction  consists  of  daily  clinical  work  and  practical 
lessons  on  patients  referred  to  our  clinics  from  various  Hospital  Dispen- 
saries. Lecturesand  Quizzes  on  Anatomy,  Physiology,  Hygiene  and  Patho- 
logy by  Physicians  of  the  staf?.  Demonstrations  and  Instruction  in  the  use 
of  all  mechanical  apparatus.  Complete  Medico-Mechanical  Zander  Gym- 
nasium,   X-Ray  and  Radium  Laboratory. 

Original  Swedish  (Ling)  system,  and  Weir  Mitchell's  Rest-Cure  system. 
AH  pupils  attend  clinics  at  several  city  hospitals.  Payments  can  be  made 
to  suit  your  convenience.  Particulars  and  illustrated  booklet  on  Massage 
upon  request.  An  early  application  for  admission  is  advis- 
able.   A  diploma  is  awarded  at  the  end  of  the  term. 

Private  Sanatorium  for  Nervous,  Medical  and  Surgical  cases,  connected 
with  the  institute.    Special  attention  paid  to  proper  diet. 

STAFF  OF  INSTRUCTORS 
J.  Madison  Taylor,  A..  M.D.  (Univ. 

of  Penn.;  Assoc.  Prof,  of  Non- 

pharmaceutic.  Therapeutics, 

Med.  Dept.  Temple  Univ.) 
Daniel  M.  Hoyt,  M.  D.  (Univ.  of 

Penn.) 

Howard  A.  Sutton,  M.  D.  (Instruc- 
tor Univ.  of  Penn.) 
George  K.  Strode,  M.  D.(lnstructor 

Univ.  of  Penn.) 
Fred  D.  Weidman,  M.D. (instructor 

Univ.  of  Penn.  and  Woman's 

Med.  College.) 
B.  B.  Vincent  Lyon,  M.  D.  (John 

Hopkins    Univ.;  Bacteriologist 

and  Pathologist  to  German  and 

Methodist  Hospitals,  etc.) 
Wm.  Erwin,  M.D. (Hahnemann  and 

Rush  Medical  College.) 
Max.  J.  Walter.  M.  D.  (Univ.  of 

Penn. ;  Royal  Univ.  of  Breslau, 

Germany,   and   lecturer   to  St. 

For  all  further  information  and  illustrated  prospectus  address  the  Sup- 
erintendent. MAX.  J.  WALTER.  M.  D.,  Supt. 


Joseph's,  St.  Mary's,  Mt.  Sinai, 
W.  Phila.  Hospital  for  Women, 
Phila.  General  Hosp.  [Blockley] 
Cooper  Hospital,  etc.) 

C.  Norwood  Wherry,  M.D.  (Jefler- 
son  Medical  College.) 

Tyra  Gowenius,  (Royal  Gymnastic 
Central  Inst,  and  Dr.  Arvedson's 
and  Dr.  Kjellberg's  Inst.  Stock- 
holm, Sweden.) 

Minna  Schmidt,  R.  N.  (Graduate 
and  Head  Nurse  City  Hospital, 
Erfurt,  Germany;  Supervising 
Nurse  Royal  University  Hospital, 
Halle,  Germany;  Post-Graduate 
Illinois  Training  School  for  Nur- 
ses, Chicago,  Illinois;  Pennsyl- 
vania Orthopaedic  Institute. 

Lillie  H.  Marshall,  Marie  E.) 

Stevenson.  Edith  W.  Knight.  > 

Elizabeth  Jamison  J 

Pennsylvania  Orthopaedic  Institute, 


ESTABLISHED  1874 


TRADE  (^AVOL)  I^ARK 

A  NECESSITY  IN  EVERY  HOME 


131 


SICK  ROOM 


Cautery  Sets 
Commode  Seat 
Complexion  Bulb 
Dental  Dam 
Diapers 
Dilators 
Cupping  Cups 
Sanitary  Covers 
Sheeting 

Stomach  Evacuator 
Stomach  Tubes 
Stoppers 
Breast  Pipes 
Breast  Pumps 
Breast  Shields 
Face  Hoods 


Face  Bottles 
Finger  Cots 

Fountain  Syringe  Bags 

Teething  Pads 

Teething  Rings 

Vaporizers 

Water  Bags 

Water  Beds 

Water  Bottles 

Water  Caps 

Woman's  Delight 

Tourniquets 

Tubing 

Turkish  Bath  Cushions 
^Umbilical  Belts 


DAVOL 


TRADE  MARK 


"HOUSEHOLD" 

(registered) 


RUBBER 
GOODS 


Urinals 
Rectal  Tubes 
Bathing  Caps 


WE  make  everything  for  the  Household  ** 
in  Rubber  Goods  and  the  largest  and  best 
line  of  Atomizers  on  the  market. 


Bulb  Enemas 
Bed  Pans 

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Insist  on  having  a  DAVOL  WATER  BOTTLE , 

and  a  DAVOL  FOUNTAIN  SYRINGE  and 

NOT-" SOMETHING  JUST  AS  GOOD' 


Syringe  Pipes 
Syringe  Shut  Offs 
Syringe  Tubing 
Syringes— Aural 
Syringes— Bag 
Syringes— Bulb 
Syringes — Combined  Fountain 
Syringes— Eye  and  Ear 
Syringes— Fountain 
Syringes — Gem 
S3rringes— Infant 
Syringes— Ladies 
Syringes— Nasal 
Syringes  -Rectal 
Syringes— Six-Ounce  Bulb 
Syringes— Urethral 
Syringes— Ulcer  and  Ear 
Syringes-  Vaginal  Douche 
Abdominal  Coils 
Air  Beds 
Air  Pillows 


Gem  Cleansers 
Gloves 
!Head  Coils 
Hospital  Cushions 
Hospital  Air  Cushions 
Household  Syringes 
Ho.usehold  Ladies'  Syringe 
Household  Vaginal  Douche 
Ice  Bags 
Ice  Caps 
Invalia  Rings 
Irrigating  Tubes 
Kelly's  Operating  Cushions 
Kidney  Pads 
Ladies'  Syringes 
Medicine  Droppers 
Marsh  Patented  Finger  Pads 
for  counting  money  or  papers 

SEE  that  the  Name  /fTTTTTn^ 
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purchase  for  home  use.  trade  mark 


ORIDER.  FROM  YOUR.  JDRUGOIST 


Neck  Pillow 
Nipple  Shields 
Nipples 

Nursing  Bottle  Fittings 
Nursery  Sheeting 
Obstetrical  Cushions 
Chair  Cushions 
Chemists*  Covers 
Chemists'  Culture  Caps 
Chemists'  Stoppers 
Colon  Tubes 
Pessaries 
Pile  Pipe 
Pillpw  Vents 
Plant  Sprinklers 
Plaster  Bowls 
Politzer  Bags 
Powder  Blowers 
Bandage  Gum 
Bandages 
Barbers'  Bibs 
Barbers'  Atomizers 
Basin,  Folding 
Bath  Tubs 
Bath  Spray 


DAVOL  RUBBER  COMPANY 

MANUFACTURERS  OF 

STRICTLY  HIGH-GRADE  RUBBER  GOODS  FOR  THE  ** HOUSEHOLD'' 
PROVIDENCE.  R.  I.,  U.  S.  A. 

521 


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A.  F.  PATTEE 
134  South  First  Avenue  Mount  Vernon,  N.  Y. 

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Mops  and  Brushes  for  all  Purposes 


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Brushes 

These  Dusters  are  sold  in  5000  stores  in  U.  S.  and  used  by 
2000  Public  Buildings,  Institutions,  School  Boards  and  Colleges. 

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places. 

These  goods  are  sent  prepaid  by  parcel  post  on  receipt  of 
retail  price.  Small  sample  and  illustrated  catalogue  and  price 
list  sent  free. 

Address 

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200  Summer  St.,  Boston,  Mass. 


523 


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For  further  particulars 
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Kansas  City,  No, 


524 


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The  famous  heavily  rock  ballasted,  double  tracked,  aufo- 
matic  safety  signal  line  between  Chicago  and  the  Missouri 
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is  included  in  the  wonderful  system  of  the  Chicago 
and  North  Western  Line, 

It  is  the  direct  route  and  provides  unequaled  train 
service  from  Chicago  to 

Ashland  Eau  Claire      Marquette  Oshkosh 

Boone  Fond  du  Lac   Marshalltown  Pierre 

Cedar  Rapids  Green  Bay  Mason  City  Rochester 
Clinton  Huron  Milwaukee        St,  Paul 

Council  Bluff s    La  Crosse       Minneapolis     Sioux  City 
Des  Moines         Madison         Oakes  Superior 
Duluth  Mankato         Omaha  Winona 

the  Black  Hills  and  other  important  points  in  Illinois.Wisconsin, 
northern  Michigan,  Minnesota,  Iowa,  Nebraska,  Wyoming,  the 
Dakotas,  Colorado,  Utah,  California  and  the  North  Pacific  Coast. 

The  Best  of  Everything 

For  tickets,  reservations  and  full 
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525 


Pattee's 
Hand=Bag  Diet  Book 

Consisting  of 

Measures  and  Weights,  Recipes 
and  Hospital  Dietaries 

REPRINTED  FROM 

Pattee's  **  Practical  Dietetics  with 
Reference  to  Diet  in  Disease" 


IN  response  to  requests   from  a  large  number 
of  nurses  these  extracts  from  the  Pattee's 
Practical  Dietetics  with  Reference  to  Diet 
in  Disease"  have  been  collated  into  a  small  book, 
suitable  for  the  nurse's  hand-bag. 

It  is  bound  in  heavy  paper  and  is  sold  only 
to  nurses,  purchasers  of  the  complete  edition. 
Those  who  do  not  purchase  both  the  complete 
book  and  the  Hand- Bag  Diet  Book  at  the  same 
time  can  obtain  the  latter  only  when  the  coupon 
on  the  opposite  page  is  forwarded  to  the  publisher 
or  bookseller  from  whom  book  was  purchased 
and  is  accompanied  by  the  nurse"'s  professional 
card  or  hospital  order  and  the  price  of  the 
book.  Orders  will  not  be  filled  unless  these 
instructions  are  followed. 

Price  of  Pattee's  Practical  Dietetics"  ($1.50 
postpaid)  with  one  copy  Pattee's  Hand-Bag  Diet 
Book,  $1.75  postpaid. 

This  booklet  is  not  published  for  general  circula- 
tion, simply  for  the  convenience  of  the  nurse  for 
her  hand-bag  equipment. 


526 


COUPON 


The  possession  of  this  coupon  entitles  any 
nurse  to  the  right  to  purchase  one  copy  of  Pattee's 
Hand-Bag  Diet  Book. 

Send  this  coupon  with  your  professional  card 
or  hospital  order  and  30  cents  to  the  publisher  or  to 
the  bookdealer  from  whom  the  book  was  purchased, 
and  a  copy  will  be  forwarded  postpaid. 

A.  F.  PATTEE,  Publisher 
Mount  Vernon  New  York 

Name  . 

Address  


527 


INDEX  TO  SUPPLIES 

FOR  THE" 

HOSPITAL-HOME-PHYSICIAN-NURSE 

FOODS: 

Cox's  Gelatine    495 

Crackers — Bent's  Water  Crackers,  Cracknels,  N.  B.  C.  Gra- 
ham Crackers,  N.  B.  C.  Oatmeal  Crackers,  Uneeda  Bis- 
cuits, Water  Thins,  N.  B.  C.  Zwieback   481 

Dr.   Brush's   Kumyss   502-503 

Fleischmann  Yeast    501 

Franco- American  Broths   491 

Holt's  Noblesse   Flour    493 

Horsford's  Acid  Phosphate   478 

Horlick's  Malted  Milk    487 

Hoyt's  Gum  Gluten   488-497 

Jell-O   483 

Junket    480 

Junket  Brand  Buttermilk  Tablets   480 

Lactopeptine   492 

Laibose   482 

Liquid  Peptonoids    492 

Minute  Tapioca   : . .  484 

Moxie    529 

Nicelle  OHve  Oil   489 

Panopepton    482 

Peptonising  Tubes   482 

Preserves,  etc.,  Home-made    490 

Rumford  Baking  Powder    446 

Thompson's  Vegetable  and  Cereal  Flour   499 

Walter  Baker's  Breakfast  Cocoa    477 

Welch's  Grape  Juice    485 

MISCELLANEOUS  SUPPLIES: 

Bill  Book  and  Ideal  Record,  WilHs  &  Co   509 

Borolyptol    492 

Chicago  &  North  Western  Railway   525 

Coupon  for  Pattee's  Handbag  Diet  Book   527 

Coward  Shoe    511 

"Davol"  Rubber  Goods    521 

Dietitians    498 

Dietitians'  Registry   486-504-519 

Dix-Make  Uniforms    507 

Excelsior  Quilted  Mattress  Pads   516 

Fellows'  Syrup  of  the  Hypophosphites    479 

Gazette  Pocket  Speller    506 

Gingham  for  Nurses'  Uniforms    522 

Home  Bureau    508 

Hospitals    496 

Howard  Dustless  Duster   523 

Hygeia  Nursing  Bottle    517 

Ideal  Nurse  Report,  Wm.  V.  Willis  &  Co   509 

Institution  Recipes   •'  494 

"Neal"  Bath  Tub  for  Children    514 

Nurses'  Journals    510 

Nurses'  Journal  Combination  Offer   500 

Packer's  Tar  Soap    464 

Pattee's  Handbag  Diet  Book    526 

Pennsylvania  Orthopaedic  Institute  and  School  of  Mechano- 

Therapy    520 

••Smith"  SoUtaire  Board    524 

"Storm"  Binder  and  Abdominal  Supporter   515 

Surgery  Publishing  Company    518 

The  Surgical  Assistant    512 

Vapo-Cresolene    513 

Walker  Dishwasher    505 

By  writing  to  the  above  firms  useful  literature  and  samples  will 
be  forwarded  upon  request.  In  writing,  mention  Pattee's  Practical 
Dietetics  and  prompt  attention  will  be  given  to  your  letter. 

528 


Drink 


/ 


